Registration Launch Session 1 - 2025 MONDAY AUG 5 – FRIDAY AUG 9, 2025 1Student Info2Parent / Guardian Info3Mailing Address4Emergency Contacts5Payment Student InformationStudent First Name*Student Last Name*ESM Counselor (Name or N/A)*Student Phone Number*Student Email* Grade Entering*9th10th11th12thSchool*Shirt Size*Dietary Restrictions*Gender*MaleFemaleNonbinaryPrefer not to disclosePrefer to self-describeGender Identity* Parent / Guardian InformationParent / Guardian First Name*Parent / Guardian Last Name*Parent / Guardian Email* Parent / Guardian Phone Number* Mailing AddressStreet Address*Address Line 2City*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP / Postal Code* Emergency Contact InformationEmergency Contact Name*Emergency Contact Phone*Emergency Contact Relation to Student*Emergency Contact Name*Emergency Contact Phone*Emergency Contact Relation to Student* Payment InformationLaunch Day 1 - Registration FeeCredit Card*Card Details Cardholder Name Discount Code Total $0.00 NameThis field is for validation purposes and should be left unchanged.
