Summer IMPACT Camp
June 2019
 
 
Please note that a partial tuition payment of $175 is due with the application. The final $175 is due 3 weeks prior to the 1st day of camp. 
Acceptance into the camps is not guaranteed until the full tuition ($350) has been received.
Payment can be made online. 
After completing the form you will be directed to the online payment page.
 
Questions? Email youth@thevolunteercenter.org 
 
 
Your Email:
 *
Student First Name
 *
Student Last Name:
 *
Gender
 *
Student's Cell:
 *
Student's Home #:
 
Parent/Guardian Full Name:
 *
Parent's Email:
 *
Parent's Cell:
 *
Parent Work #:
 *
Parent/Guardian Full Name:
 
Parent Email:
 
Parent Cell:
 
Parent Work#:
 
Mailing Address:
 *
City:
 *
State:
 *
Zip:
 *
School Name:
 *
County of School Attending 2018-2019:
 *
Food Restrictions
 
Allergies (list all)
 
Medical Conditions:
 
Preferred Hospital:
 
Age as of May 31, 2019
 *
How did you hear about our IMPACT Camps:
 *
Check the desired week:
We believes strongly in supporting all students and as much offer financial assistance as possible. Please complete the scholarship application form on the website. Contact adrienne@thevolunteercenter.org for more information on Financial Aid.
If you are requesting a scholarship to be used for tuition assistance please check here
Click here if you are affiliated with any of the following organizations: Durham TRY, Student U, the Emily K Center, Partners for Youth Opportunity (PYO), or Youth Empowered Solutions (YES)
 *
Week 1 (June 17-21)
Week 2 TBD
Both Weeks
Verification Code:
Insert above code:
 * Required


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