Request edit access
Bottle Works Winter Camp 2019- Enrollment Form
Enrollment Form
Student's Name *
Your answer
Student's age at time of camp *
Your answer
Student's Birthday *
MM
/
DD
/
YYYY
Gender
Student's Current Grade *
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 FIRST Name *
Your answer
Parent/ Guardian's LAST 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 camp: *
Your answer
Any additional information we should know about the student ?
Your answer
How did you hear about Bottle Works Winter Camp
Next
Never submit passwords through Google Forms.
This form was created inside of Bottle Works Ethnic Arts Center. Report Abuse