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Register for Camp Cosmos 2025

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Last name*

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Phone Number*

Student First Name*

Student Last Name*

Student Home Address*

Student's Birthday*

Month

Day

Year

Current Grade Level*

What grade is your genius currently in?

Current School Name*

T-Shirt Size*

Emergency Contact Full Name*

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Allergies or Medical Conditions? (If Yes, Please Explain)*

I give permission for my child to participate in Camp Cosmos 2025.

I authorize the program to seek emergency medical care if needed.

I give permission for photos/videos of my child to be used in program media.

I understand that attendance and participation are expected each day.

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