Virtual Summer Camp Interest Survey
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Child/Camper Name
First Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Female
Male
School
Grade
Are you interested in enrolling your child in this virtual summer camp?
Yes
No
What do you expect your child to learn from this summer camp?
What is your motivation on why you want to enroll your child in this summer camp?
What programs are you planning to enroll your child to?
Painting
Sketching
Cooking
Singing
Dancing
Acting
Chess
Sports
Academic Tutoring
Musical Instrument
What are the usual time of day you prefer your child to participate to?
Morning (7:00am-10:00am)
Afternoon (1:00pm-4:00pm)
Late Afternoon (4:00pm-7:00pm)
If physical summer camp will be an option, will you let you child participate?
Yes
No
Do you have the following equipment for virtual activities? Please select all that you have:
Internet connection
Desktop/laptop/mobile/smart phone
Web camera
Microphone
Headphone
We are open for any suggestions or feedback.
Submit
Should be Empty: