Dec. 30 - Dec. 31, 2019 One Day Camp Registration Form
Princeton Ririxin School
48 Carter Road
Princeton, NJ 08540
Phone (609) 896-1290
Child 1 Name; Gender; Age *
Child 2 Name; Gender; Age
Parent/Guardian Name *
Address *
Email *
Telephone Number *
Emergency Contact and Relation *
Does your child suffer from any allergies, illnesses, disabilities, or other medical conditions? If yes, please explain below.
Medical Release Agreement and Parental Consent: Students are expected to carry their own accident and/or medical insurance. In the event of injury or illness, every effort will be made to contact the parent or guardian. If necessary, I authorize Ririxin to administer first aid and/or authorize medical treatment if this becomes necessary. (please sign by entering your initial below)
Photo/Video Release: I grant permission to Ririxin the irrevocable and unrestricted right to produce photographs and video taken of my child(ren) while at Ririxin summer school for any lawful purpose including publication, promotion, illustration, and advertising in any manner. I hereby release Ririxin and its legal representatives from liability for any violation or claims relating to said images or video. (please sign by entering your initial below)
Please indicate how many children from your household attending Robotics program: *
Please choose the camp date: *
Required
PRS reserves the right to cancel classes based on enrollment. *
Required
Please sign by entering your full name; date below *
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