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Bottle Works Summer Camp 2019- Enrollment Form
Enrollment Form
Name of Student *
Your answer
Student's Age *
Your answer
Student's Birth Date *
MM
/
DD
/
YYYY
Gender
Student's Grade Entering in Fall *
Your answer
Student's School District
Your answer
Have you attended a Bottle Works Camp in the Past
Student's T-shirt Size *
Your answer
Parent/ Guardian's Name *
Your answer
Parent/ Guardian's email address *
Your answer
Parent/ Guardian's phone number *
Your answer
Parent/ Guardian's Address *
Your answer
Secondary emergency contact *
Name/ Relationship/ Phone number
Your answer
Additional emergency contact person
Name/ Relationship/ Phone number
Your answer
I give my Child/ Children permission to go on short walks around the Bottle Works, the Cambria City neighborhood, and the Honan Trail. *
Required
Please list the adults who are allowed to drop off and/or pick up the student during the week of camp: *
Your answer
Any additional information we should know about the student ?
Your answer
How did you hear about Bottle Works Summer Camp
If the camp week includes a field trip, do you give your child permission to attend? Please select yes or no. If you select yes, you the agree to the means of transportation and trip location.
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