CEF-SBEC Youth Entrepreneurship Summer Camp Registration Form

Dates: July 24 - August 11 M-F 9 am – 4 pm

Address: Wang Center, Stony Brook

1 Circle Road, Stony Brook, NY 11974

Name*

Student First NameStudent Last Name

Student Grade in Fall 2023*

Student School Name & Town*

Student Phone*

Student Email*

example@example.com

Re-enter Student Email*

example@example.com

Home Address*

Parent Name*

Parent First NameParent Last Name

Parent Email*

example@example.com

Re-enter Parent Email*

example@example.com

Parent Phone*

Select Date*

Early Bird (Register by 5/1) $3000 payment received by 5/5Regular (Register by 5/31) $3500 payment received by 6/3Other (Register after 6/1, $3500 payment immediately due if seat is still available)

Need before or after care?

Before care 8am- 9am ($20 per day, specify the dates:)After care 4pm- 5pm ($20 per day, specify the dates:)

Specify the before care dates:*

Specify the after care dates:*

Promo Code

Total Payment of $ total payment* will be made after the completion of the registration form.

Notes for us

How did you hear about this program (check all apply):

Please specify WeChat group:*

Please specify Social Media*

Please specify Local Advertisement*

Agreement (Non‐Negotiable):*

I, the parent or Guardian of the said student, hereby grant permission for my child toattend Youth Entrepreneurship Summer Camp at Stony Brook University. I grant this CEF-SBEC the right to take and use photos & videos of my child for promotional purposes.I, the parent or Guardian of the said student, hereby agrees to reimburse CEF-SBEC for any property damage caused by the student. I understand that there will be no refunds after the program starts or for a student who has been expelled due to disciplinary actions. The camp director reserves the right to dismiss a student who, after careful consideration andexamination, is deemed as hazard to the safety or rights of others or who appears to have rejected the reasonable expectations of the program. I have been fully informed, and am in fullagreement with the conditions of enrollment.I, the parent or Guardian of the said student, authorize CEF-SBEC and all its’ staff to act according to their best judgment in any emergency requiring medical attention. I here by waive and release CEF-SBEC and/or its designees from all liabilities and costs associated any and all medical treatment provided. I acknowledge that it is the policyof CEF-SBEC to notify a parent when a child is ill or needs medical attention. I acknowledge that if CEF-SBEC cannot contact a parent and theyneed to get immediate help for the child, the procedure is to take the child to the nearest emergency service or call 911/ ambulance help. I hereby consent to this procedure and further agree to pay all costs incurred.The parent or guardian shall be liable for any damages and/or injuries caused by the student.

Signature*

Print Your Name*

Date*

MonthDateYear