World Language Camp Application

Personal Information

First Name:_______________________________

Middle Name:_______________________________

Last Name:_______________________________

Nickname:_______________________________

Date of Birth:_______________________________

Gender: Male / Female

T-Shirt Size:_______________________________

 

Course Preference

Spanish

French

 

Address

Street Address or PO Box:______________________________________

Apartment/Unit #:____________________________

City:______________________________

State:_____________________________

Postal Code:__________________________

County:_____________________________

 

Contact Information

Home Phone:______________________________

Cell Phone:_____________________________

Email Address:_____________________________

School Information:___________________________

High School:________________________________

Principal's Name:______________________________

School Phone:_________________________________

GPA:___________________________________

 

Family Contact Information

Name(s) of Parents: _______________________________

Father's Home Phone: ______________________________

Father's Work Phone: _______________________________

Father's Cell Phone: _______________________________

Mother's Home Phone: _______________________________

Mother's Work Phone: _______________________________

Mother's Cell Phone: _______________________________