Registration

Camping in Point Mugu - 3 days 2 nights. $50 per person, $100 per student for 12+ if traveling without parent/guardian.

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: *
	Emergency Contact Info*

Students entered below will be added to your family's account

Questions/Options:


Traveling with parent/guardian? Please note. All students are required to register.*
Please list all adults who will be attending.
Please list any allergies (e.g. to Medications, Food)
Solo traveler 12 Vegan/Vegetarian?
Solo traveler 12 Child’s Health Information: Please list physical/mental health conditions (e.g. Asthma, Diabetes)
Solo traveler 12 Please list any prescription medications.
Solo traveler 12 Please list the following: Insurance Company Name, Policy/Group Number, Policy Holder. Email Photocopy of Insurance Card to anna@urbanhomeschoolers.com.

Additional Information: