The Short List: Boot Camp Registration

Boot Camp
Sunday, July 19 – Saturday, July 25, 2015

Summer Program Application

Please complete this form in order to apply for The Short List Summer Program. The full price of the program is $3,950. At the end of the Student Information section you may upload a recent color photo. If you do not have a photo readily available, you will still be able to submit your application and later email a photo to TSLCamp@theshortlist.org.

* = required field

Student Information

*First Name : Middle Name : *Last Name : Preferred Name : *Your Email :

*Gender : Female Male

* Date of Birth :

* Your Country of Citizenship Your Mailing Address : Your City : Your State Your Zip : * Your Country of Residence * Your Home Phone : Your Cell Phone : Please attach a recent photo of yourself :

Parent Information

Father's Name : Father's Address : Father's City : Father's State : Father's Zip Code : Father's Country Father's Home Phone : Father's Cell Phone : Father's Work Phone : Father's Email :

Mother's Name : Mother's Address : Mother's City : Mother's State : Mother's Zip Code : Mother's Country Mother's Home Phone : Mother's Cell Phone : Mother's Work Phone : Mother's Email :

Do you have a legal guardian? Guardian's Name : Guardian's Address : Guardian's City : Guardian's State : Guardian's Zip Code : Guardian's Country Guardian's Home Phone : Guardian's Cell Phone : Guardian's Work Phone : Guardian's Email :

Emergency Contact

*In Case of Emergency Contact: Father Mother Both Guardian

Academic Information

Please indicate your school type: Public Independent Parochial Home school

* School Name : School Address : * School City : * School State : School Zip : *School Country : *Anticipated Graduation Date :

Reference Information

*Please indicate how you learned about our program: You are a current TSL Client Family Member/Friend -- please specify:
Teacher -- please specify:
Emailing/Mailing TSL Website Advertisement -- please specify: Other -- please specify:

*Program T-Shirt Size

Please Select Sizes (Adults S-XL) :
Small Medium Large X-Large

Payment Information

You will receive an invoice for this program once you have submitted your application. There is a 50% deposit of $1,975 due by May 15, 2015 with the balance of $1,975 due by June 15, 2015.

You may also print and mail your application to:

The Short List Summer Camps
292 Main Street, #16
Great Barrington, MA 01230