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Elementary School Summer Camp 2024 Sign Up

Student first name

Student last name

Home address

Student gender

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Student date of birth

Student grade level (2023-2024 school year)

Student Race/Ethnicity

African-American or Black

American Indian or Alaskan Native

Hispanic/Latinx

Middle Eastern

East Asian

South Asian

Native Hawaiian or Other Pacific Islander

Bi/Multi-Racial

White

Other

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T-shirt Size (Youth Sizes)

Any Dietary Restrictions?

Yes

No

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Any Known Allergies or Medical Conditions?

Yes

No

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Does your child require any special learning accommodations

Parent and Emergency Contact Info

Parent first name

Parent last name

Email

Emergency Contact Name

Emergency Contact Number

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460 South Highland Street. Suite 901, Memphis, TN 38111 | 901-229-1720 | team@code-crew.org | #GritGrindCode

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