The Hive, LLC: DEBATE & MUN

The Hive, LLC: DEBATE & MUN

Little River Farm, 269 Newtown Turnpike, Redding, CT 06896
SUMMER PROGRAM August 2021

COMBINED REGISTRATION & RELEASE

Applies to all practice sessions, events and related activities, including travel.

Tuition:

Debate: August 16-20, 11a-3p ($250)*

Model United Nations: August 16-20, 3:30-5:30 p ($150)*

TO RESERVE YOUR SPOT:
1. COMPLETE THIS FORM.
2. SUBMIT $50 nonrefundable DEPOSIT (or tuition in full) via check payable to The Hive, LLC, or "friends & family" PayPal at paypal.me/jghunt, or Venmo @jghunt.
*Program dates are final for the week, August 16-20. Times may change slightly, depending on mode of delivery, given changing health circumstances. Email jenniferhunt@thehive.academy with any questions.
Student Name*

First NameMiddle NameLast Name
Sessions Selected:*

Debate (8/16-20, 11a-3p)MUN (8/16-20, 3:30-5:30p)
Student Birthdate*

MonthDayYear
Date
School & Grade:*
Student E-mail*
example@example.com
Student Cell

Area CodePhone Number
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Debate, MUN, or Related Experience:*
What are your goals for this program?*
Parent #1 Name*

First NameLast Name
Parent #1 Email*
example@example.com
Parent #1 Cell*

Area CodePhone Number
Parent #2 Name

First NameLast Name
Parent #2 Email
example@example.com
Parent #2 Cell

Area CodePhone Number
Additional Emergency Contact

First NameLast Name
Emergency Contact Cell

Area CodePhone Number

In Case of Emergency:
Preferred Local Hospital*
Insurance Company*
Policy #*
Primary Physician*
Name (Doctor/Practice)
Primary Physician Phone*
Phone Number
Allergies*
Please explain below.
Medication*
Please explain below.
Any other concerns or comments? (Include any special contact information or medical/personal information you would want an emergency provider to know.)

Please click to indicate assent.*
Please click to indicate assent.*
Please click to indicate assent.*
Regarding the foregoing, I have read, understand, and agree to abide by all documented, and verbally amended, Policies and Procedures. I acknowledge that I have read and understand this entire agreement consisting of
1. Consent to Supervision & Medical Care,
2. Consent to Media Use, and
3. General Liability Release,
and I agree to be legally bound by it, as evidenced by my signature below.
PARENT SIGNATURE*
STUDENT SIGNATURE*
Should be Empty:

In Case of Emergency: