GenCyber Girls in CybHER Security Middle School Residential Camp 2022

Date/Time
Date(s) - Sunday, June 19, 2022 - Thursday, June 23, 2022
All Day

Location
Dakota State University

Categories

Spaces

Attendee 1

Child Name *

Child Last Name *

Child DOB *

School Attending

Grade Going Into Fall 2022 *

Each camper will room with one other camper.
If you have a roommate request, please enter her name and grade level here.

Has Child Attended GenCyber Camp Previously?

Shirt Size (Adult Sizes) *

Child Allergies *

Medical Conditions *

Parent/Guardian Information

UserName *

Parent First Name *

Parent Last Name *

Email *

Alternate Email

Employer

Address *

City/Town *

State *

Zip *

Cell Phone *

Check if this is the primary emergency contact.

Parent 2/Guardian Information

Parent 2/Guardian First Name

Parent 2/Guardian Last Name

Parent 2/Guardian Gender

Parent 2/Guardian Employer

Parent 2/Guardian Cell Phone

Check if this is the primary emergency contact.

Waivers
All parents must read and agree to our Waiver of Liability.
By checking the box below you are agreeing to the waiver.

I Agree to Waiver *

All parents must read and agree to our DSU Photographic Release.
By checking the box below you are agreeing to the photo release.

Photo Release *

I agree to pick up my camper if she gets ill. *