Youth Ilm Summer Camp Registration
You can register more than one youth in this form. If you have any questions, email education@masbayarea.org
Join Mailing List
Donate
Join WhatsApp Group
Parent Information
First Parent Name
*
First Name
Last Name
First Parent Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
First Parent Email
*
example@example.com
Second Parent Information
How many children are you registering
*
1
2
3
1st Child Information
*
2nd Child Information
*
3rd Child Information
*
Emergency Contact (Please enter contact information for an emergency contact (different than parent) who we can contact in case parents cannot be reached)
*
Back
Next
How many weeks are you registering your children for?
*
Both Weeks (June 15-25)
Week 1 Only (June 15-18)
Week 2 Only (June 22-25)
Youth Ilm Summer Camp
*
prev
next
( X )
1st Child
$
450
Both Weeks
1 Week Only
Item subtotal:
$
0.00
2nd Child
$
430
Both Weeks
1 Week Only
Item subtotal:
$
0.00
3rd Child
$
430
Both Weeks
1 Week Only
Item subtotal:
$
0.00
Participation Consent/Waiver
*
I hereby grant consent for my child to participate fully in the program and all associated activities, including surveys used to inform future programming, unless I provide written notice otherwise. MAS Bay Area reserves the right to restrict or prohibit participation if my child is not following program rules and may remove any participant from the program without refund if they fail to comply with rules or engage in behavior that is harmful to others.
Liability/Medical Waiver
*
By submitting this form, I release and agree to indemnify and hold harmless MAS Bay Area and its officers, employees, agents, and volunteers from any liability, claims, damages, or costs arising from my and/or my child’s participation in MAS Bay Area events, classes, camps, and activities, whether conducted at MAS Bay Area Office or any other sites where such events may take place. In the event of a medical emergency, MAS Bay Area personnel will make every reasonable effort to contact me or the listed emergency contact. In the case we cannot be reached, I authorize the MAS Bay Area designated personnel to treat my child for any injuries, illnesses, or conditions that may occur at the camp/activity. This includes onsite and offsite emergency care.
Photo Release Authorization
*
I grant permission for photos or videos taken of me or my child(ren) during MAS Bay Area events/classes/camps/activities to be used on the MAS Bay Area website, in brochures, on social media, and in newsletters for promotional, educational, or informational purposes.
I do not give permission to be photographed, and if I am, I request that my photo not be published.
Make Payment
Should be Empty: