Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent/Guardian Name

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please choose one:

We will submit the payment through Venmo to @gershonalexa

We will submit the payment through Zelle to director@shorestrongsummer.com

If referred by someone, please share their name below

First Name

Last Name