CAMP REGISTRATION FORM

Directions: Please read carefully, complete the form (1 registration form per child) and sign.

Camper Address:   Street Address   Address Line 2   City   State   Zip
Guardian Primary Phone:      Area Code. Phone Number  
Camper Phone (if applicable):   Area Code   Phone Number   
Guardian E-Mail:   Email   

EMERGENCY CONTACT INFO:

Emergency Contact Name :     First Name   Last Name   
Emergency Contact Phone :   Area Code   Phone Number   
 Relationship to Participant:     Type a label   

MEDICAL INFO:

Insurance Co     Company Name + ID      
Preferred Hospital:   Preferred Hospital      
Name of Docter    Doctor Name

"Release of Liability" WAIVER:

By signing this registration form, I agree to the following “Release of Liability” Waiver: In consideration of the risk of injury while participating in this camp, and as consideration for the right to participate in this camp, I knowingly enter my camper into this waiver and release of liability and hereby waive any and all rights, claims, or causes of action of any kind arising in my camper's participation, Laura K Moore Photography, their affiliates, managers, members, agents, staff, volunteers, representatives, for any physical or psychological injury, that my scholar may suffer as a direct result of my camper's participation in this camp.