* 1.
Question - Required -
Child's name:
* 2.
Question - Required -
Child's current grade:
* 3.
Question - Required -
Child's birthdate:
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
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31
Year
Year
2039
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1924
4.
Question - Not Required -
If registering multiple children, please list their name, grade, and birthdate here.
* 5.
Question - Required -
Name of parent/guardian:
* 6.
Question - Required -
Parent/guardian phone number:
* 7.
Question - Required -
Parent/guardian email:
* 8.
Question - Required -
Camper behavioral, medical, or other special considerations (please type "none" if your child does not have any special considerations)
(Maximum response 255 chars, approx. 5 rows of text)
9.
Question - Not Required -
Please include any other information that may be helpful:
(Maximum response 255 chars, approx. 5 rows of text)
10.
Question - Not Required -
(Optional) T-shirt size
If purchasing a T-shirt for your child, please indicate size choice below.
* 11.
Question - Required -
The following demographic questions help us track our work toward diversity, equity, and inclusion, and apply for funding to support our work. Your child's information is being used only for overall reporting and will not in any way affect your eligibility for, or participation in, our programs.
What is your child's ethnicity?
Please select response
Hispanic or Latino
Not Hispanic or Latino
Do not wish to provide
* 12.
Question - Required -
The following demographic questions help us track our work toward diversity, equity, and inclusion, and apply for funding to support our work. Your child's information is being used only for overall reporting and will not in any way affect your eligibility for, or participation in, our programs.
Which race does your child primarily identify with?
Please select response
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Do not wish to provide
* 13.
Question - Required -
How did you hear about Cozy Critters Camp?
Please select response
WHS Website
Howler, WHS e-newsletter
E-mail from WHS Youth Programs
Miltown Moms Blog
Facebook
Saw or received a flyer
Friends/Family
Other
14.
Question - Not Required -
If "Other" please specify: