FREEPORT 2019 CAMP REGISTRATION
By submitting this form you represent that you are 18+ years of age or have parental consent to complete this form. Your name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of the Morlon Greenwood Foundation, MG52, and House Of Dutch Pot which may be used in any public forum without compensation being paid to you nor any authorized representative.
Name
*
First Name
Last Name
Your School Name
*
Grade / Education Level
*
College - Senior
College - Junior
College - Sophomore
College - Freshman
12
11
10
9
8
7
6
5
4
3
2
1
Email Address
*
example@example.com
Male/Female
*
Male
Female
Your Birthday
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: