SUMMER CAMP ENROLLMENT FORM

SUMMER CAMP ENROLLMENT FORM
STUDENT INFORMATION

If you have more than one student you'd like to enroll, please contact us !
Name*

First NameLast Name
GENDER*

MALEFEMALE
AGE*
DATE OF BIRTH*
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
PARENT GUARDIAN #1
PARENT/GUARDIAN INFO*

First NameLast Name
RELATIONSHIP TO STUDENT*
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PLACE OF EMPLOYMENT
HOME PHONE*
Please enter a valid phone number.
WORK PHONE
Please enter a valid phone number.
EMAIL*
example@example.com
EMERGENCY PHONE*
Please enter a valid phone number.
PARENT GUARDIAN #2
PARENT/GUARDIAN INFO

First NameLast Name
RELATIONSHIP TO STUDENT
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PLACE OF EMPLOYMENT
HOME PHONE
Please enter a valid phone number.
WORK PHONE
Please enter a valid phone number.
EMAIL
example@example.com
EMERGENCY PHONE
Please enter a valid phone number.
EMERGENCY CONTACT LIST

I understand if I don't answer any emergency phone calls, CTSO and The MRS Project summer camp is authorized to release my child(ren); or get in touch with the person(s) listed below.
EMERGENCY CONTACT #1*
EMERGENCY CONTACT #2*
EMERGENCY CONTACT #3*
EMERGENCY CONTACT #4
EMERGENCY CONTACT #5
MEDICAL INFORMATION
DOES YOUR CHILD HAVE ANY FOOD/MEDICINE ALLERGIES?*

YESNO
IF SO PLEASE LIST THE FOLLOWING ALLERGIES:
DOES YOUR CHILD HAVE ANY PHYSICAL OR EMOTIONAL DIFFICULTIES WE SHOULD BE AWARE OF?*

YESNO
IF SO PLEASE LIST THE FOLLOWING:
JOURNEYS:

I thereby grant permission for First Name* Last Name*, a student at CTSO and The MRS Project summer camp in accordance with the arrangements that have been made for outdoor adventures and other activities at CTSO and The MRS Project summer camp. CTSO and The MRS Project summer camp shall not be held accountable for any negligible incidence that may occur.
I ACCEPTI DECLINE
Photography/video/sound:I thereby grant CTSO and The MRS Project summer camp authority to utilize the name, photograph, video, sound recording, and project work of the student(s) listed for marketing or promotional reasons, whether digital or otherwise. For concerns of safety, we make an effort to keep student names apart from their imagery.*

I ACCEPTI DECLINE
My Products*
prevnext( X )
Summer Camp StudentEnter description
$50.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

SUMMER CAMP ENROLLMENT FORM

STUDENT INFORMATION

PARENT GUARDIAN #1

PARENT GUARDIAN #2

EMERGENCY CONTACT LIST

MEDICAL INFORMATION

JOURNEYS: