Safety Camp 2018 Week 1 Camp Ahava Registration Form

Aish Camp Ahava
We are so happy you will be joining us!

We are going to have a blast!
How many children will be attending *

1 2 3
What days will your child be attending camp? *

June 11 June 12 June 13 June 14 June 15
Child/Children's info *
Parent's Information
Mother's Name *

First Name Last Name
Mother's Email *
Mother's Cell *
Address, City, State, Zip *
Home Phone:
Father's Name

First Name Last Name
Father's Email
Father's Cell Phone

Father's address (if different than Mom's)

Parental Consent for Emergency Treatment
I hereby consent to allow the administrators of the Aish Camp Ahava to take whatever medical measures necessary at my expense, for my child, in the event of a medical emergency.

(To Sign: Click and Drag your mouse to form your signature)
Signature *

Clear
Date: *

- Month - Day Year
Date
Liability Waiver Release and Indemnification
I, the undersigned parent of *
I hereby consent to my child's participation in Aish Camp Ahava activities. I hereby release and indemnify Aish Camp Ahava, their affiliates, agents, officers, supervisors, and employees (herein referred to collectively as "Aish Camp Ahava") from and against any and all claims for property damages or personal injuries which my child may sustain. I further agree to indemnify and defend against any and all claims for property damages 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 may be used by Aish as well as Aish Camp Ahava for their marketing purposes.
Signature *

Clear
Date: *

- Month - Day Year
Date

Registration is not complete until you have paid and clicked the "Submit Form" button below. The cost is $40 per child per day or $175 for the week. Please enter the number of kids next to the days that you'll be sending.

Payment

Next to each date select the number of kids attending

Dates	Price	select number of kids
June 11	$ 40.00
June 12	$ 40.00
June 13	$ 40.00
June 14	$ 40.00
June 15	$ 40.00
Full Week (Do Not Mark Individual Days)	$ 175.00

Item subtotal: $ 0.00

Enter coupon

Total $ 0.00