NCRCLS New Summer Camp Account Application Form


If you are returning students or registered students in 2017 Spring, please go directly to
our 2017 Summer Camp registration page

In order to establish your account for NCRCLS, we need the following personal
information from you. This information will be treated confidentially. 

  Home Phone Number:       
  (Area code with no - or space)
  
  Father's Name:           
  (Last, First)
  
  Mother's Name:           
  (Last, First)  

  Street Address:          
  City:                    
  State:                   
  Zip:                     
  
  Email address:           
  
  Mobile Phone:            
  (Area code with no - or space)
  
  Father's Work Number:       
  (Area code with no - or space)
  
  Mother's Work Number:       
  (Area code with no - or space)  
  
  Emergency Contact:        
  (Last, First)
  
  Emergency Contact Number: 
  (Area code with no - or space)
  

  Please check the courses you or your kids are going to take this semester (2017 Summer):
 
SelectedCourse IDStudent NameBirth DateGender
Student 1 (Last, First)//(mm/dd/yyyy)
Student 2 (Last, First)//(mm/dd/yyyy)
Student 3 (Last, First)//(mm/dd/yyyy)
Student 4 (Last, First)//(mm/dd/yyyy)
Student 5 (Last, First)//(mm/dd/yyyy)
Student 6 (Last, First)//(mm/dd/yyyy)
Have you used this system before? Yes No If you have never used this system before, please select your password: Password: (At least 8 characters) Retype Password: (At least 8 characters) Before you submit your application, you might want to print your application form for future reference.