ENROLLMENT FORM

ENROLLMENT FORM
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.Format: (000) 000-0000.
PARENT GUARDIAN #1
PARENT/GUARDIAN INFO

First NameLast Name
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PLACE OF EMPLOYMENT
HOME PHONE
Please enter a valid phone number.Format: (000) 000-0000.
WORK PHONE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
EMERGENCY PHONE
Please enter a valid phone number.Format: (000) 000-0000.
PARENT GUARDIAN #2
PARENT/GUARDIAN INFO

First NameLast Name
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PLACE OF EMPLOYMENT
HOME PHONE
Please enter a valid phone number.Format: (000) 000-0000.
WORK PHONE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
EMERGENCY PHONE
Please enter a valid phone number.Format: (000) 000-0000.
EMERGENCY CONTACT LIST

I understand if I don't answer any emergency phone calls, The MRS Project 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:
I thereby grant permission for First Name Last Name, a student at The MRS Project, to travel in accordance with the arrangements that have been made for outdoor adventures and other activities at The MRS Project. The MRS project shall not be held accountable for any negligible incidence that may occur.
I ACCEPTI DECLINE
Photography/video/sound:I thereby grant The MRS Project 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
Should be Empty:

ENROLLMENT FORM

PARENT GUARDIAN #1

PARENT GUARDIAN #2

EMERGENCY CONTACT LIST

MEDICAL INFORMATION