PRIZE : 2024 WCU PRIZE Summer Teacher Academy Online Registration

2024 WCU PRIZE Summer Teacher Academic Online Registration

All fields are required except where noted.

Student Information

Please make sure you have filled in all required fields with valid information.

Student First Name:

Student Last Name:

Student Address:

Student City:

Student State:

Student Zip:

Age:

Gender:

T-Shirt Size:

Dietary Concerns:

Yes No

Briefly explain dietary concerns (allergies, vegan, vegetarian, etc.):

Parent/Guardian #1 Information

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Parent #1 First Name:

Parent #1 Last Name:

Parent #1 Address Same as Student Address

Parent #1 Address:

Parent #1 City:

Parent #1 State:

Parent #1 Zip:

Parent #1 Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Parent #1 Email:

Confirm Parent #1 Email:

Parent/Guardian #2 Information (all optional)

Please make sure you have filled in all required fields with valid information.

Parent #2 First Name:

Parent #2 Last Name:

Parent #2 Address Same as Student Address

Parent #2 Address:

Parent #2 City:

Parent #2 State:

Parent #2 Zip:

Parent #2 Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Parent #2 Email:

Confirm Parent #2 Email: