6th Grade Camping Trip Registration

MomDad

Your Name*

FirstLast

Your Primary Email Address*

Your Primary Phone Number*

Area CodePhone Number

For how many students are you submitting this registration?*

Name of Student 1*

FirstLast

Will Student 1 be climbing/repelling?*

Name of Student 2*

FirstLast

Will Student 2 be climbing/repelling?*

My son will be sleeping in a tent*

Classmate's FATHER'S Name*

Classmate's FATHER'S Name / Email Combination

Classmate's FATHER'S Email

example@example.com

Will dad attend the campout?

Dropdown List Dad's Emails

Dropdown List Dad's Names

Dropdown List Dad's Cell Number

Dad's Name*

Dad's Email*

Dad's Cell Number*

Will you be present for the entire duration of the campout?

Enter the date and times when you will arrive and depart the campout

Emergency Contact Information

Emergency Contact Name*

FirstLast

Emergency Contact Phone Number*

Area CodePhone Number

Emergency Contact Relationship to Student(s)*

Notes (any allergies or medical conditions?)

Parent or Guardian Permission and Acknowledgement
• The student(s) in this registration has(have) my permission to participate in all camping activities.
• Photographs of this(these) student(s) participating in this activity may be used in school publications (unless he is already on the No Pictures List).

I am a parent guardian of the student(s) in this registration, and understand and permit the above.

By checking this box and typing my name below, I am electronically signing this registration form.

Electronic Signature Step 2. Type your name.

FirstLast

NOTE:

If dad will attend the campout then he must fill out the Western Academy Child Protection Code of Conduct document. This form will be sent out digitally to the email entered above for dad's email. Please have dad review, digitally sign and submit the document.

If you have any questions, please reach out to your son's homeroom teacher or Head of School.

Head of Middle School - Alex Hoff, alex.hoff@westernacademy.net