Individual Academic Therapy 2023 Registration

A $250 non-refundable deposit is required within one week of registration. An invoice will be sent to you via email with balance due in full by June 16th. No portion of camp is refundable. All summer programs will be closed on Tuesday, July 4th.

Child's Name *

Gender *

Male

Female

Non-Binary

Age *

Current School *

Date of Birth *

Month

Day

Year

Grade completed in June 2023 *

How did you hear about CBA's Summer Enrichment Program? *

If other, please specify:

Parent/Guardian Name *

Address *

City *

State *

Zip *

Mobile Phone *

Email Address *

Emergency Contact Person's Name *

Relationship to Child *

Mobile Phone *

My child could really use help with:

Media Release *

Yes

I authorize Chesapeake Bay Academy to use, reproduce, and/or publish photographs and/or video of my enrolled child – including name, likeness and/or voice. I understand that this material may be used in various publications, recruitment materials, or for other related endeavors. This material may also appear on the Chesapeake Bay Academy website and or social media channels. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, Chesapeake Bay Academy may publish materials, use my name, photograph, and/or make reference to me in any manner that Chesapeake Bay Academy deems appropriate in order to promote/publicize marketing and communication opportunities.

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Individual Academic Therapy 2023 Registration