Muse Squad Summer Camp Registration Form
Chapter (Town of Class)
example: New Milford
Student Information
Full Name
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Email Address
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
Parent/Guardian Information
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Student
Photo Release: As part of our creative writing program, we may take photographs or videos of students during class activities, events, and workshops. These photos/videos may be used for promotional purposes, including but not limited to marketing materials, social media posts, websites, or newsletters related to the program. By checking "I consent" below, you grant permission for your child's image and/or likeness to be used in such materials.
I consent to the use of my child's image for promotional purposes as described above.
I do not consent to the use of my child's image for promotional purposes.
To stay up to date on news, articles and events, would you like to subscribe to 'A Time to Write Bulletin'?
Yes, keep me in the loop! (You can unsubscribe at any time)
No, not at this time.
I'm already subscribed.
Emergency Contact
Full Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Payment
Payments of $200 can be (i) mailed by check to Muse Squad PO Box 564, Ridgefield, CT 06877, (ii) brought to the first class, OR (iii) sent via Zelle to (475) 529-8728.
Financial Assistance
Payment plans available.
Reach out for more information to
info@musesquad.org
.
Date and Signature
Today's Date
-
Month
-
Day
Year
Date
Digital Signature: By digitally signing your name below, you acknowledge that your digital signature has the same legal effect and enforceability as your handwritten signature. You agree that your digital signature is an authentic representation of your intent and authorization, and you understand that it carries the same rights, obligations, and consequences as a physical signature.
Continue
Continue
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