CCA Robotics Summer Camp 2022

Registration Form

Our goal as a camp is to create a collaborative and fun atmosphere for preteens and middle school students that allows them to become aware of and excited about science, technology, engineering and math. We want to provide a safe space where students can explore and develop a passion for new subjects that they might desire to pursue in middle school, high school, and throughout the rest of their lives. Each Session offers a new challenge and curriculum, please consider signing up for multiple sessions to maximize your student's experience.

Open to Students entering 1st through 6th Grade in the Fall of 2022

Monday - Friday

Session 1: REGISTRATION CLOSED

Session 2: FULL

Session 3: July 25- July 29, 2022

9:00 a.m. - 3:00 p.m.

at Canyon Crest Academy

Insight Camp, Grades 1-4, $500 per session/student

Curiosity Camp, Grades 5&6, $525 per session/student

Aftercare option until 5 p.m.: $100 per session/student

Participant Information

How many students are you registering? (max 5) *

First Name *

Last Name *

Birth Date +

Grade This Fall *

Sex *

T-Shirt Size (Unisex sizes) *

Grades 1-4. Please choose your Insight session(s)

CLOSED

FULL

Session 3 July 25-29

Grades 5&6 Please choose your Curiosity session(s)-2 *

CLOSED

FULL

Session 3 July 25-29

N/A

Please choose your Aftercare session(s)

CLOSED

FULL

Session 3 July 25-29

First Name - 2 *

Last Name - 2 *

Birth Date - 2 * +

Grade This Fall - 2 *

Sex -2 *

T-Shirt Size - 2 (Unisex sizes) *

Grades 1-4. Please choose your Insight session(s)-2 *

CLOSED

FULL

Session 3 July 25-29

N/A

Grades 5&6 Please choose your Curiosity session(s)-2 *

CLOSED

FULL

Session 3 July 25-29

N/A

Please choose your Aftercare session(s)- 2 *

CLOSED

FULL

Session 3 July 25-29

N/A

First Name - 3 *

Last Name - 3 *

Birth Date - 3 * +

Grade This Fall - 3 *

Sex -3 *

T-Shirt Size - 3 (Unisex sizes) *

Grades 1-4. Please choose your Insight session(s)-3 *

CLOSED

FULL

Session 3 July 25-29

N/A

Grades 5&6. Please choose your Curiosity session(s)-3 *

CLOSED

FULL

Session 3 July 25-29

N/A

Please choose your aftercare session(s)-3 *

CLOSED

FULL

Session 3 July 25-29

N/A

First Name - 4 *

Last Name - 4 *

Birth Date - 4 * +

Grade This Fall - 4 *

Sex -4 *

T-Shirt Size - 4 (Unisex sizes) *

Grades 1-4. Please choose your Insight session(s) - 4 *

CLOSED

FULL

Session 3 July 25-29

N/A

Grades 5&6. Please choose your Curiosity session(s) - 4 *

CLOSED

FULL

Session 3 July 25-29

N/A

Please choose your aftercare session(s) - 4 *

CLOSED

FULL

Session 3 July 25-29

N/A

First Name - 5 *

Last Name - 5 *

Birth Date - 5 * +

Grade This Fall - 5 *

Sex -5 *

T-Shirt Size - 5 (Unisex sizes) *

Grades 1-4. Please choose your Insight session(s) - 5 *

CLOSED

FULL

Session 3 July 25-29

N/A

Grades 5&6. Please choose your Curiosity session(s) - 5 *

CLOSED

FULL

Session 3 July 25-29

N/A

Please choose your aftercare session(s) - 5 *

CLOSED

FULL

Session 3 July 25-29

N/A

Current Total:

$0.00

Parent / Guardian Information

Relationship to Participants: *

First Name *

Last Name *

Address 1 *

City *

State *

Zip *

Phone *

Email Address *

Health Insurance Information

Student First Name *

List any physical or emotional limitations including food allergies your child/participant may have: *

Student First Name - 2 *

List any physical or emotional limitations, including food allergies your child/participant may have: *

Student First Name - 3 *

List any physical or emotional limitations including food allergies your child/participant may have: *

Student First Name - 4 *

List any physical or emotional limitations including food allergies your child/participant may have: *

Student First Name - 5 *

List any physical or emotional limitations including food allergies your child/participant may have: *

By Checking this box I confirm that the participant(s) is/are covered by Health Insurance. Students must have Health Insurance to participate in this camp. Please provide Insurance Information below. *

I confirm that the participant(s) and is/are covered by Health Insurance.

Health Insurance Carrier *

Health Insurance Policy Number *

READ THIS RELEASE AND WAIVER

By clicking on this form you confirm that you have read and agree to all terms in the above release and waiver. *

I agree to the terms in the Release and Waiver