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California State University, Long Beach
Academic Enrichment Camp
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Academic Enrichment Camp Application

All fields with (*) are required.

Emergency Contact
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(Example: 562-985-1111)
Child Information
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Gender required * *
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(mm/dd/yy format. Example: 12/01/99)
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(Provide a copy of I.E.P if applicable)
Camp Session Enrollment

Please select the session(s) in which you wish to enroll your child. If you want to enroll in BOTH sessions (6/22 - 8/14), please select BOTH boxes.

  • Morning Supervision: 7:15 - 8:30 AM ($15 per family per session)
  • 49er CAMP: Separate application and fee. Please contact 562-985-4049 for details
Session 1: 6/22-7/17 Session 1 and Morning Supervision
Session 1 with NO additional service
Session 1 and attending 49er CAMP
Session 2: 7/20-8/14 Session 2 and Morning Supervision
Session 2 with NO additional service
Session 2 and attending 49er CAMP
Parent Information
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*
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(Example: 562-985-1111)

(Example: 562-985-1111)
Other authorized person beside parents to pick-up the child/children

(Example: 562-985-1111)

Check All that Apply

Staff/Faculty Member (*) ; if "Yes":
CSULB ID Department Position Ext
CSULB Student (*) ; if "Yes": CSULB Student ID
Multiple Children Enrolled in Academic Camp Session 1 (**). If "Yes": Name of Sibling(s)
Multiple Children Enrolled in Academic Camp Session 2 (**). If "Yes": Name of Sibling(s)

NOTE:
(*) $25 per family discount
(**) $25 additional child discount

Online Payment Options

Please check which one applies to you: required

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NOTE: After submitting this Application you will:
1. Be directed to our secure online payment processor CASHNET
2. Receive enrollment confirmation email

Consent