Student Registration - Teen Central

* Indicates required field
 
Tuition: $65.00
 
Student First Name *
Student Last Name *
Student's Preferred Pronouns
Student Date of Birth *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Email *
Please enter an email address that is actively monitored. The email address entered will be used to set up your account and will receive all communications about account billing and camp details.
Is Parent/Guardian a Central Piedmont Employee? *
Address *
City *
State *
Zip *
School Attending *
School Type *
If Other, please specify
Current Grade *
Parent/Guardian: Phone *
Emergency Contact Name *
Emergency Contact Phone *
How did you hear about us? *
Promotional Code