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WAITLIST – SPARK! Mosaic

2026 WAITLIST – SPARK! Mosaic

June 15 – June 26 (two weeks), Monday-Friday, 8:30 am – 12:30 pm Ages: Middle and High School

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Student's Information

Student's Name*
MM slash DD slash YYYY
SNAP Participant?*
Student's Address*

Parent/Guardian's Information

Parent/Guardian's Name*

Emergency Information

Emergency Contact's First Name*

Photography/Media Acknowledgment

BY ACKNOWLEDGING AND TYPING MY NAME BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
A $25 deposit is required to reserve your child’s spot. It is fully refundable if canceled before June 15 or after your child completes at least 50% of camp. Refunds will be issued by June 26 (please allow 5–10 business days for processing).
Deposit Donation Agreement
Payment Method*
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa