NAZA Summer Youth Enrollment Form
Introduction
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Program Offering Exists - Hidden Field
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Yes
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Program Information
Program Name
Program Description
Introducing Humble Beginnings’ Academy of Sports Science!!! The perfect blend of sports and STEAM. This is an exciting opportunity for children grade 5-8 to engage in a wide range of activities that promote both physical fitness and intellectual growth. Campers will participate in fundamental training stations allowing them to enhance their coordination, overall fitness and ability to work as a team. In addition to sports, the camp also offers STEAM activities (Science Technology Engineering Arts and Mathematics). Through hands-on experiments, workshops, challenges, and projects, campers will have the chance to explore their creativity, problem-solving abilities, and critical thinking skills. They will learn about concepts such as physics, computer programming, and design principles, all while having fun and making new friends. So, if you're looking for a summer camp that combines sports, STEAM, fun and fitness look no further!
Program Director Name
Program Director Email Address
Programs
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Student Information
Student First Name
Student Last Name
Name student would like to be called
Birthday
Student ID #
All ID numbers are 9 digits & begin with "190"
Gender
Male
Female
Other
State preferred gender identity
Is Student Home Schooled?
Yes
No
School
2024-2025 School Year Grade
Please select...
5
6
7
8
9
Address Information
Address
City
State
Zip Code
Parent/Guardian Information
Parent/Guardian 1
Parent/Guardian First Name
Parent/Guardian Last Name
Relationship to Student
Primary Email
Phone
Lives with Student?
Yes
No
Street Address
City
State
Zip
Would you like to add an additional Parent/Guardian?
Yes
No
Parent/Guardian 2
Parent/Guardian First Name
Parent/Guardian Last Name
Relationship to Student
Email
Phone
Lives with Student?
Yes
No
Street Address
City
State
Zip
Emergency Contact
Emergency First Name
Emergency Contact Last Name
Emergency Contact Phone Number
Medical Information
Preferred hospital if your child needs medical care
Note: If not applicable add "N/A"
Primary Doctor Name
Note: If not applicable add "N/A"
Doctor Phone
Note: If not applicable add "N/A"
Does your child have medical insurance?
Yes
No
Insurance Information
Health Insurance Company Name
Policy #
Medicines?
Yes
No
If yes, please give us details on the medication so we can care for your child properly.
Allergies or Food Restrictions?
Yes
No
If yes, please give us details on allergies or food restrictions so we can care for your child properly
Physical restrictions?
Yes
No
If yes, please give us details on physical restrictions so we can care for your child properly
Any educational needs or special accommodations?
Yes
No
If yes, please give us details on the educational needs or special accommodations so we can care for your child properly
Contact Information