BEES Summer Camp

Application
2017 Summer Camp Application

* $190 Total
**Make all checks out to Patterson Park Public Charter School**

Date Completed: _____/_____/_____

Name of Student: _____________________________________________

Name of Parent/Guardian: _____________________________________

Mailing Address:
_____________________________________________________________

Email Address: ________________________ Phone Number:

___________________

Student Age: ______ Date of Birth: _____/_____/_____

Grade Level (2017-2018 school year) 4 5 6 7 8

Emergency Contact Information:

Name: _______________________ Phone Number: _________________________

Relationship to Camper: _________________________________

Contact Information:
Ryan Kaiser
rkaiser@bcps.k12.md.us
Address:
_____________________________________________________________________

Contact Information:
Ryan Kaiser
rkaiser@bcps.k12.md.us