Chatsworth Hills Academy

Phone: (818) 998-4037 • Fax: (818) 998-4062
Email: info@chaschool.org

21523 Rinaldi St, Chatsworth, CA 91311
P.O. Box 5077, Chatsworth, CA 91313
Neighbor Hotline (818) 998-4037 x313

CAMP Request Form

Student Information *Required Fields
*Child 1 Name:			Child 2 Name:
*Child 1 Birthdate:			Child 2 Birthdate:
*Child's 1 Entering Grade:			Child's 2 Entering Grade:

Contact Information
*Parents Name			How did you hear about us?
*Home Address:
*City			Questions / Comments:
*State and Zip Code::
*Country:
*E-mail:
*Contact Phone:


			Please Type the following letters into the box beside it: CHA