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(386) 518-6300

Camp CSI Application

Name
Address
Is English your primary language?
Gender
Do you have a Social Security card?
If “No”, you must obtain a valid card before registering for this course
Have you been a resident of Florida continuously during the last five (5) years?

Answering “Yes” to the following question does not necessarily mean you cannot be certified.

Have you EVER been convicted of, or entered a plea of guilty, nolo contendere, or no contest, to a crime in any jurisdiction other than a minor traffic offense? You must include all misdemeanors, felonies, and juvenile offenses, even if adjudication was withheld. Driving under the influence (DUI) or driving while impaired (DWI) is not a minor traffic offense for purposes of this question.

In the event we are unable to contact you at the phone number listed above, please provide two (2) additional contacts:

Full payment at time of signing Student Enrollment Agreement

Applicant Agreement(Required)