Summer Camp Pre-registration Form

Registration Fees must be completed in order to complete registration process online.

Only one camper may be registered at a time.

Camper's Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date*

MonthDayYear

Current Age:*

Gender:*

MaleFemale

Phone Number*

Area CodePhone Number

E-mail Address where you'd like to receive confirmation and information:*

Camp Session(s) camper is registering for:*

T Shirt Size

Please provide emergency contact.

1st Emergency Contact Name*

First NameLast Name

1st Emergency Contact Relationship:*

1st Emergency Contact Daytime Phone Number:*

Area CodePhone Number

1st Emergency Contact Evening Phone Number if different:

Area CodePhone Number

Please list other important emergency contacts, their relationship to camper, best phone numbers or other contact information that will be helpful in an emergency.

I, as the registered am 18 or over, or I am a parent or legal guardian of the registered who is currently under the age of 18, grant permission for the registered camper to attend GBASO Camp and consent to its Discipline Policy and also do hereby release GBASO from any and all liability or responsibility due to any injury that he/she/I may incur as the result of, or arising in any way from participation in activities at or under the direction of GBASO. I am fully aware and consent to accept these risks and voluntarily agree to allow his/her participation in activities. If I cannot be consulted in an emergency, I hereby give permission to the physician selected by a representative of GBASO to secure treatment for the person named above. I furthermore understand GBASO often takes photographs or videos of participants during its activities or events. I grant permission without compensation that these photographs or videos may be used in publications, presentations, websites or promotion of GBASO.

Electronic Signature: By entering my name below, I accept the above conditions and releases. (You must be 18 years old or over to sign below.)*

First NameLast Name

Relationship to registered camper:*

Current Date:*

MonthDayYear

A 50% refund of camp fee is made if notice is given to GBASO seven days prior to camp date. No refund will be made once the camp starts.

Upon completion of filling in all areas of form, click "Submit Form". Do you have questions or need help with online registration? Email Shane at shane.stout@GBASO.org

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