SUMMER CAMP APPLICATION

Application Deadline is June 12, 2013
Please fill out the following form and submit  and someone will contact you shortly. You
may reserve your seat in advance.
Student  name/s:
Your email address:
Your home number &
cell phone number:
Address
Parents or Guardian
Name:
Student Grade Level
Completed
Age
Emergency Contact
T-shirt size/s
X-Sm, Sm, Med, Lg,
X-Lg, 2X, 3X
Special Needs & Requests, Foods that your child may be allergic, etc...
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*Please make your payment on our Summer Camp page for
Summer Camp Registration Fee. Make checks payable to
Math Tutors In Houston. Thank you.