Summer Camp Registration Form

1st annual Excel Summer Project has teamed up with EBR to assist the youth in reaching their fullest potential and goals.

Excel Care will be starting enrollment on April 25th. Free breakfast and lunch provided for all clients.

Classes start on June 6th to Aug 5th for kids ages 7-14.
Several courses will be provided such as:
Reading
Math
Decision making strategies and counseling
Acting, singing and music production
Business financial management and crypto currency investment

Camps will be free for all those who qualify. Please register at excelcarela.org or call

our office at 225-361-0219. Limited space available.

All information on this form is required by Camp Excel and LA Excel Care to ensure the safety of your
child. Please thoroughly fill out all information so that it is and accurate. Only completed
registrations will be accepted.

Once the form is completed hit the "Preview" button.
Go over the form to make sure everything is filled out, then hit the "Register button at the bottom of the form".

Birth date:

Child's Name

Participant Information:

Age:

Male

Address

School

Grade

Mother / Guardian's Name:

Home Phone

Cell Phone

Work Phone

When a parent is NOT authorized to pick-up, we must have a copy of court documentation. Please provide copies of
court documentation with registration as needed

Child's Shirt Size (choose one). Camp participants are required to purchase 2 shirts ($5 each) and we will provide 2 shirts (Friday's are free dress day:)

Youth XSm (2-4)

Youth Sm (6-8)

Youth Med (10-12)

Youth Lg (14-16)

Adult Sm

Adult Medium

Adult Large

Adult XL

Emergency Information:

(Must list at least one additional emergency contact. No one under the age of 18 is permitted)

Emergency Contact:

Home Phone

Cell Phone

Work Phone

Relationship:

Summer Camp Registration Form

Participant Information:

Emergency Information:

Office Use Only

Current Client? ___________________________________________

(If no, do they qualify for services)?

Referred by: ____________________________________

Insurance Provider: ____________________________