🎵 Register – **REFRESH PROJECT***

Student Information

Child Name*

First Last

If you have more than one child, each child must be registered separately.

Age*

Please enter a number from 10 to 17.

Date of Birth*

Grade Level in Fall 2022*

School/District*

Name of School*

Education Type*

Regular Education

Special Education

Height*

Weight*

Sex*

Male

Female

Eye Color*

Brown

Green

Blue

Hazel

Ethnicity*

Student Address*

Street Address City State Zip Code

County in Which Child Resides*

Wayne County

Oakland County

Macomb County

Kent County

Other

Parents/Guardian the Student Has (Check All That Apply)*

Mother

Father

Step-Mother

Step-Father

Guardian

Who Does the Student Live With? (Check All That Apply)*

Mother

Father

Step-Mother

Step-Father

Other

Who Does the Student Live With?*

Number of Siblings in the Home*

Primary Language Other Than English

Is your child a returning Keys 2 Life or SWAG program participant?*

Select Yes to this question if your son or daughter attended a Keys 2 Life camp or SWAG program last year or in any previous year.

Yes

No

Are you applying for a scholarship?*

Yes, I desire a discounted camp cost if I qualify

No, I will pay the full price

Parent/Guardian Information

Name of Parent/Guardian Completing This Form*

First Last

Email Address of Parent/Guardian Completing This Form*

Your Preferred Method Of Communication*

Email

Text

Phone Call

Cell Phone Number of Parent/Guardian Completing This Form*

Father's Information

Father/Legal Guardian*

First Last

Father's Address*

Street Address City State ZIP Code

Father's DOB

Father's Home Number

Father's Work Number

Father's Mobile Number

Father's Email

Mother's Information

Mother/Legal Guardian*

First Last

Mother's Address*

Street Address City State ZIP Code

Mother's DOB

Mothers Home Number

Mothers Work Number

Mothers Mobile Number

Mother's Email*

Step-Father's Information

Step-Father*

First Last

Step-Father's Address

Street Address Address Line 2 City State ZIP Code

Step-Mother's Information

Step-Mother*

First Last

Step-Mother's Address

Street Address Address Line 2 City State ZIP Code

Scholarship Application Section

Do you participate in the free lunch program at your school?*

Yes

No, we don't qualify

No, my school doesn't have that program

What is the annual income of your family?*

How many dependents are in your family?*

Are you a single-income family?**

Yes

No

Does the child for whom you are applying receive child support?**

Yes

No

Please explain any extenuating circumstances related to your financial need? (100 words or less)

Congratulations!

Great news! Your child qualifies for a scholarship and has been awarded a discount for this year's camp! IMPORTANT: Please complete the rest of this Registration Form as soon as possible as scholarships are limited and go fast. A completed registration is the only way to retain your scholarship. You will see your discount factored into the total cost of the camp on the last page. Congratulations!

Complete Your Registration

2023 Summer Camp

Final Total Due Today

Total

Your total balance due today is ZERO. Congratulations on your receipt of a FULL scholarship for your child to attend Keys 2 Life Camp at absolutely no cost. To finalize your registration and retain your full scholarship, press the COMPLETE REGISTRATION button below as soon as possible.

Please Enter Your Credit Card Information*

Please verify Cardholder Name

First Last

Billing Address*

Street Address City State ZIP Code

Hidden

Date

IMPORTANT:

Please be sure to click the COMPLETE REGISTRATION button below ONLY ONE TIME and then be patient while your registration processes. This may take up to 30-60 seconds or more depending on your internet speed. Once the registration form fully processes, you will be redirected to a confirmation page, and you will also receive an e-mail confirmation.

SUMMER CAMP REGISTRATION FORM

Directions:

Student Information

Camp Preferences

Parent/Guardian Information

Father's Information

Mother's Information

Step-Father's Information

Step-Mother's Information

You are doing great!

Click next to continue.

Survey: Getting to Know Your Child

Next to each topic on this page, place a check mark next to any statement that accurately describes your child. If your child is experiencing any of the following behaviors, you may be eligible for increased support and resources.

Scholarship Application Section

Congratulations!

Referral Information

Camp Policies & Consent Statements

Complete Your Registration

IMPORTANT:

HAVE A PROGRAM QUESTION NOT ADDRESSED ON THIS WEBSITE?

313-870-9771

K2LCamp@theyunion.org

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