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Camden Summer Camp Registration
Build new skills and friendships! Workshops are for kids 11-18 and are facilitated by coaches and Squad members. Join us from July 13-24, 9am-3pm. Parents are encouraged to stay and watch their children discover the magic of social circus! Tuition is FREE. The Camden Squad meets at the Michael J. Doyle Fieldhouse, a Community Center and Gymnasium, located at 1840 S. Broadway, in Camden’s Waterfront South.
Parent/Guardian Name
*
Parent First Name
Parent Last Name
Acct Record Type
Contact Record Type Participant
Household Name
Contact Record Type General
Full Name Parent
Parent/Guardian Gender
*
Male
Female
Nonbinary
Choose not to respond
Relationship to Participant
*
Phone Number
*
Please enter a phone number.
Format: (000) 000-0000.
Parent Email Address
*
example@example.com
Home Address
*
Street Address & Apt
Street Address Line 2
City
Please Select
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Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
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Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Language Spoken at Home
*
English
Spanish
Other
Emergency Contact
Other than Parent/Guardian
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relationship to Participant
*
Emergency Contact Phone Number
*
Please enter a phone number.
Format: (000) 000-0000.
Emergency Contact Email Address
*
example@example.com
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For funding purposes only
Are you head of household?
Yes
No
Are you 62 years of age or older
Yes
No
Are you disabled?
Yes
No
Race
Black/African American
Black/African American & White
Asian
Asian & White
Native Hawaiian/Pacific Islander
American Indian
American Indian & White
American Indian & Black/African American
White
Other Multi-Racial
Ethnicity
Hispanic Ethnicity
Not Hispanic Ethnicity
Household Size
Type a number between 2 and 8
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Participant Registration
Name1
*
First Name1
Last Name1
Birth Date
*
-
Month
-
Day
Year
Date
Last Date of Year
-
Month
-
Day
Year
Date
Is the Partipant disabled?
*
Yes
No
Age1
Program1
Closing
Race
*
Black/African American
Black/African American & White
Asian
Asian & White
Native Hawaiian/Pacific Islander
American Indian
American Indian & White
American Indian & Black/African American
White
Other Multi-Racial
Ethnicity
*
Hispanic Ethnicity
Not Hispanic Ethnicity
Gender
*
Female
Male
Nonbinary
Choose not to respond
Participant Cell Phone
Please enter a phone number.
Format: (000) 000-0000.
Participant Email
example@example.com
School Name
*
Injuries/Illnesses/Medical Conditions/Current Medication
*
Accommodations Necessary for Participation
*
Please list any of the following: Medication allergies, food allergies, dietary restrictions or chronic health concerns.
Does Participant Have Health Insurance
Yes
No
Do you wish to register more participants?
*
Yes
No
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Additional Participant2
Name2
First Name2
Last Name2
Birth Date2
*
-
Month
-
Day
Year
Date
Age2
Participant Type2
Is the participant disabled?
Yes
No
Gender
Female
Male
Nonbinary
Choose not to respond
Race
Black/African American
Black/African American & White
Asian
Asian & White
Native Hawaiian/Pacific Islander
American Indian
American Indian & White
American Indian & Black/African American
White
Other Multi-Racial
Ethnicity
Hispanic Ethnicity
Not Hispanic Ethnicity
Participant Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Participant Email
example@example.com
School Name
Injuries/Illnesses/Medical Conditions/Current Medication
Accommodations Necessary for Participation
Please list any of the following: Medication allergies, food allergies, dietary restrictions or chronic health concerns.
Does Participant Have Health Insurance?
Yes
No
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Permissions and Waivers
I hereby give permission for TCS staff to administer first aid as needed
In the event of an emergency when parent, guardian, and emergency contact cannot be reached, I hereby give permission to the medical personnel selected by TCS to administer emergency care.
I give permission for the image and voice of the participant to be used by the Trenton Circus Squad in any media for publicity.
I give permission for the participant to travel by car with the Trenton Circus Squad staff.
I give permission for the participant to leave Trenton Circus Squad unaccompanied.
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