Cedar Hollow Kicking Bear Adventure day
Registration form - September 7, 2019 | 12:00pm - 8:30pm | Grayling, MI
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This form must be signed by a PARENT or LEGAL GUARDIAN; one form can be submitted for each family. The Attendee does not have to be a legal guardian.
Choose one option; If you are bringing your own children as well as others, each parent/guardian needs to complete this form separately. *
Parents or legal guardians will be responsible for the registered youth.
A friend, adult family member, or mentor of the youth will be responsible.
How many Kids from your family will be attending? *
1
2
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6
Full name of youth
First Name
Last Name
Age of youth listed above
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Full name of youth
First Name
Last Name
Age of youth listed above
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Full name of youth
First Name
Last Name
Age of youth listed above
4
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13
Full name of youth
First Name
Last Name
Age of youth listed above
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13
Full name of youth
First Name
Last Name
Age of youth listed above
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13
Full name of youth
First Name
Last Name
Age of youth listed above
4
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13
Full name of youth
First Name
Last Name
Age of youth listed above
4
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How many parents will be attending (this can change day of)
1
2
3
Parent/Guardian Attending
First Name
Last Name
Parent/Guardian Phone number
-
Area Code
Phone Number
Address of youth and legal guardian
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Attending
First Name
Last Name
Parent/Guardian Attending
First Name
Last Name
Emergency Contact name
First Name
Last Name
Emergency Contact Phone number
-
Area Code
Phone Number
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Email (used to send reminders or updates on weather)
example@example.com
Note: This website is HIPAA compliant. May we administer regular first aid including ambulance if deemed appropriate?
YES
NO
Do you authorize hospital or doctor to administer necessary medical treatment?
YES
NO
As the parent or legal guardian, I acknowledge that the above information is to be used in lieu of an Emergency Medical Release Form (found on event webpage) and that the Attending Adult named is responsible for my child/children while at camp if different from parent.
I agree
As the parent or legal guardian, I have read the Release of Liability and Assumption of Risk Agreement (found on event webpage) and I fully understand its terms, and understand that I have given up legal rights by clicking and signing this form, and I do so freely and voluntarily without any inducement.
I agree
As the parent or legal guardian, I have read the Release of Liability and Assumption of Risk Agreement (found on event webpage), and I fully understand its terms, and understand that I have given up legal rights by clicking and signing this form, and I do so freely and voluntarily without any inducement.
I agree
Any Questions or Comments?
Submit
Should be Empty: