Camp Fun Quest Registration Form

First Name*

Last Name*

Middle Name*

Gender*

MaleFemale

Address*

City*

State*

Zip*

Birth Date*

MonthDayYear

Grade entering in the fall*

School*

Please select a camp week or day*

Which camp would your child like to attend Early Birth Registration - April 1st*

$275 - Full Day Camp Week (9a.m - 3p.m)$175 - AM Half Day Camp Week (9a.m - 12p.m)$175 - PM Half Day Camp Week (12a.m - 3p.m)$75 - One Day Camp (9a.m - 3p.m)$55 - Full Week Early Drop (8a.m - 9a.m)$55 - Full Week Early Drop (3p.m - 4p.m)

Parent/Legal Guardian*

Relation*

Work Phone

Area CodePhone Number

Cell Phone*

Area CodePhone Number

Emergency Contact Name(if parent or guardian is not avaliable)*

Emergency Number*

Area CodePhone Number

Be certain to enter your email address correctly on the registration form to receive confirmation via email with in 2 weeks

Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)*

First Time Camper?*

YesNo

Any activity the camper should be restricted from?*

Any physical, mental or other condition that would require special attention or medication while at camp?*

List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.*

List any allergies (ex: bees,peanuts, dairy)*

Any dietary needs that we should know about?*

How did you hear about Camp Vertex Labs Academy?

By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I certify that my child has my permission to attend camp and participate in all activites.

I release the organizers from any liabilities, loss, damage, and fees during the program or while on the premise.
I indemnify and hold them harmless from any injuries or demands that may be sustained by my child.
I accept the risks that are associated with my child when we/I decided to allow him/her to participate in Vertex Labs Academy activities.
I authorize the organizers to take photos and videos of my child during the program and while on the premise. I allow them to use this for educational, advertising, and marketing purposes provided that they value our privacy with respect and will not associate it with unpleasant situations.
I acknowledge that my child is in good mental and good physical condition.
I am the parent/legal guardian of the participant, I am fully competent and I am above 18 years of age.
I have read and understand the waiver agreement above and by signing this document, I hereby agree and confirm that I will abide by it.

Electronic signature, please initials*

Camp Vertex Labs Academy Registration

Camper's Information

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Health Information

Other Information

Camper Waiwer