North Central Kansas Technical College
Summer Boot Camp - Registration Form

1. Please complete all questions as completely and accurately as possible
2. Submit this registration by May 1st.
3. Please send payment to address found below.

The North Central Kansas Technical College does not discriminate on the basis of sex, race, color, religion, national origin, age, handicap or marital status in admission or access to, or treatment of, or employment in its programs and activities. If you have questions regarding the below, please contact the NCKTC Dean of Student Services (1.800.658.4655).

Registration Requirements:
The information furnished to the college will not be used to deny admission but is needed for reporting purposes. Please review the following Registration requirements before proceeding.  Campers must be entering their Junior Year of High School or later.

Persons not meeting the above requirements must contact the Camp Director prior to enrollment.
Jason Rinaldo
Phone: 785-738-9070 or Email

* Indicates the question is required to submit the form.

*Today's date Camp Dates: May 28 - May 31, 2019
Personal Information
*First name  *Last Name
Middle Initial *Email address
Note: Your E-mail address must be accurate as you will receive confirmation at this address.
*Telephone Number * Cell Phone Number 
*Mailing Address *City 
*State  *Zip 
Date of Birth  
High School Last Attended City   State
High School Instructor or Tech Director
Graduate?  Year of Graduation     
Gender  Are you a Kansas Resident? 
Do you have a driver's license?  
Do you plan to earn a degree from NCKTC?  
Camp Items
Camp Costs  
Camp Registration   $150.00 All Camp and Credit Costs must be paid for either prior to camp or on first day of camp.
*Student must be at least entering their Junior year in High School to receive credit
College Undergraduate Credit* - NCKTC   $352.00
T-Shirt Information: Shirt Size: Small Medium Large X-Large XX-Large XXX-Large
 I am a Junior or Senior and would like to apply to be a Technical Honor Student.
Please review the information above and make sure that the information is accurate and up-to-date.

Once this information is submitted it will take at least three business days to process.