2024 Summer AISH Camp

Parents Information
Mother's Name*

Mom's First NameMom's Last Name
Mother's Email*
Mother's Cell*

Area CodePhone Number
Mother's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Name

Dad's First NameDad's Last Name
Father's Email
Father's Cell

Area CodePhone Number
Father's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary email for us to contact*
example@example.com
How did you find out about AISH camp?*

we are a returning familyfriendemailmailingFacebookOther
We like to tag parents in pictures on our social media! What is your Instagram handle(s)? (optional)

Parental Consent for Emergency Treatment

I hereby consent to allow the administrators of the Camp Aish to take whatever medical measures necessary at my expense, for my child, in the event of a medical emergency.
Signature*

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Date:*

MonthDayYear
Date
Liability WaiverRelease and Indemnification
I, the undersigned parent of*
hereby consent to my child's participation in Camp Aish activities. I hereby release, waive, discharge and indemnify Camp Aish, their affiliates, agents, officers, directors, supervisors, and employees (herein referred to collectively as "Camp Aish") from and against any and all claims for property damages, liability or personal injuries which my child may sustain. I further agree to indemnify and defend against any and all claims for property damages, liabilities, or personal injuries which a third party may sustain by reason of any act or omission of my child.

Additionally, I understand that my child or children's pictures taken while participating in any camp activities may be used by Aish for their marketing purposes.
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Date:*

MonthDayYear
Date

Camp Tuition

Registration Fee$35.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Parents Information