We're so excited that you want to register for MAD Camp! Start your registration now...
Child's Name: *

Date of Birth: *

School Year Just Completed: *

School Attended: *

Top Three Class Choices: *

Parent's Name: *

Phone: *

Address: *

Do You Attend Church? Where? *

Emergency Contact Name: *

Emergency Contact Phone: *

Who Will Pick Up Your Child? *

Please List Any Health Concerns or Allergies... *

Additional Information You Think We Need To Know... *

May we take and use your child's photo for publicity purposes? *

We can't wait to see you at MAD Camp! Please call us at 225-664-4102 if you have questions or need further information. We'll be in touch...
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