2025 Leadership and Career Exploration Camp Registration
PARTICIPANT INFORMATION
Participant Full Name
*
First Name
Last Name
Participant Date of Birth
*
-
Month
-
Day
Year
Date
Participant Grade Level
*
9
10
Participant School Name
*
Participant Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
PARENT/GUARDIAN INFORMATION
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Participant
*
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email Address
*
example@example.com
Emergency Contact (if different)
First Name
Last Name
Emergency Contact Phone
Please enter a valid phone number.
Back
Next
MEDICAL INFORMATION
Does the participant have any allergies?
*
Yes
No
If yes, specify
Does the participant have any medical conditions we should be award of?
*
Yes
No
If yes, specify
Any dietary restrictions?
*
Yes
No
If yes, specify
Back
Next
ADDITIONAL INFORMATION
How did you hear about the Leadership and Career Exploration Camp?
What interests you about the camp?
Back
Next
Consent and Agreement
I, the undersigned, as the parent/guardian of the participant, hereby grant permission for my child to attend the Leadership and Career Exploration Camp. I understand that my child must adhere to all camp rules and guidelines, I also authorize camp staff toseek medical care in case of an emergency.
Signature
*
Date
-
Month
-
Day
Year
Date
Media Release Agreement
I hereby give permission for CTC, Brainerd Lakes Chamber of Commerce, Sourcewell and Central Lakes College to photograph, film, videotape and/or make sound recordings of my student; to quote or publish statements of my student; and to use such photographs, films, videos, sound recordings and/or other statements, foreducational and promotional/advertising materials. I understand that my studentmay be identified in any photographs, news stories, media, or publications thatthe aforementioned organizations consider appropriate for release to magazines,newspapers, organizational websites, and/or other publications. I further understand that any such photographs, films, videotapes, sound recordings and/or written works are the property of these organizations and that neither my student nor I am entitled to any compensation for or rights in these materials. I release these organizations from all liability with respect to the matters covered by this release.
Signature
Date
-
Month
-
Day
Year
Date
SUBMIT
Should be Empty: