Teen Summer Lounge Summer Camp Registration

POOF TEEN Summer Lounge Registration
Student Information
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade COMPLETED in May 2023*

6th Grade7th Grade8th Grade9th Grade10th Grade
Sibling's Name ATTENDING Camp

First NameLast Name
Grade Completed in May 2023

6th Grade7th Grade8th Grade9th Grade10th Grade
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*

Area CodePhone Number
E-mail*
Emergency Information Other than the name listed above
Emergency Contact's Name*

First NameLast Name
Relationship*
Emergency Contact Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Any food allergies please list
Tshirt size
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by POOF Teens during the selected camp.
AgreeI do not agree
What days will your teen attend?
Media Disclosure POOF & Training Event Center may periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; Public relations and marketing purposes: images printed on brochures, posters, and newsletters, or on POOF Website, Facebook Page, and/or other art, education, or news related publications. Please indicate whether you will allow publication of photographs taken of your child/children and their literacy work during classes. Names will not be included in photographs or posted on social media. We appreciate your support and would love the chance to share pictures of all of the fun being had at our Summer Reading Camp. You can also follow us on Facebook to capture all of the pictures yourself!
AgreeI do not agree
One time fee of $150 is due .
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Registration includes registration fee AND camp date selection. Students are not enrolled until full payment is received. Discount for siblings will be applied at checkout.
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POOF TEEN Summer Lounge Registration

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