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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 (6/20-7/15 & 7/18-8/12), 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: 6/20-7/15 Session 1 and Morning Supervision (additional $15 fee per camper)
Session 1 and attending 49er CAMP (separate application)
Session 1 with NO additional service
Session 2: 7/18-8/12 Session 2 and Morning Supervision (additional $15 fee per camper)
Session 2 and attending 49er CAMP (separate application)
Session 2 with NO additional service
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

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NOTE: After submitting this Application you will:
1. Be directed to our secure online payment processor CASHNET
2. You MUST PAY the deposit with the online payment option otherwise your application will NOT be processed
3. Receive enrollment confirmation email
4. Cashnet will charge 2.75% to your credit card payment.

Consent