Summer Programs (null)

Student Name*

FirstLast

Address*

Street AddressAddress Line 2CityZip Code

Phone Number*

Email

Parent Name*

School Attended

Current Grade Level (2012-2013)

Select Camp. Grade level refers to the year you are currently in not your grade level for the fall.*

You will need to complete a seperate registration for each camp. Grade level indicates grade level in 2013-2014.

Transportation Requested. Arts & Tech Camp Only.

Yes
No

Emergency Contact Name*

Emergency Contact Phone*

Are there any medical issues we should be aware of?

Permission to participate in activities.*

I agree

I hereby give permission for my son/daughter to participate in all activities associated with Summer Tech Camp. I agree NOT to hold STAFFORD TECHNICAL CENTER or its agents liable and harmless for all expenses or condition, temporary or otherwise, which may result from and accident or treatment for an accident.

Medical treatment permission.*

I agree

In the event that my daughter/son is injured and requires medical attention and the school or its agents are unable to reach me(us) or the persons listed above, I (we) hereby authorize the School or its agents to take my (our) daughter/son to a physician, physician’s assistant, medical center or hospital for treatment.

Stafford Technical Center

Summer Programs

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Summer Camp Registration