Registration

Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Insurance Company*
Policy #*
Type of Insurance: Employer/Individual/Government/Medicaid/ Medicare/Tricare*
 
Additional Information:
 
MEDICAL TREATMENT AUTHORIZATION
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I've read the above and agree.
 
MINOR CONSENT AND ASSUMPTION OF RISK STATEMENT FORM
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I've read the above and agree.
 
RELEASE
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I've read the above and agree.
 
CLAIM RELEASE
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I've read the above and agree.
 
FINANCIAL AGREEMENT/CANCELLATION
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I've read the above and agree.
 
LATE PICK UP POLICY
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I've read the above and agree.
 
FIELD TRIP RELEASE: CAMP
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I've read the above and agree.
 
VIEWING
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*