Cowboy Academy Summer Program Registration
Cowboy Academy Summer Programs and Camps are free of charge and available to all students completing Kindergarten through 12th grade. Registration Deadline is May 22nd.
*DISCLAIMER* PROGRAMMING IS SUBJECT TO CHANGE DUE TO UNCERTAINTY WITH THE COVID-19 PANDEMIC. Some of our programs are limited by class size and fill quickly. Please contact Keri VanDyke with any questions, 406-402-7359 or keri.vandyke@conradschools.org
Email address *
Student first name *
Student last name *
Age *
Birth Date *
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Recent grade completed *
Parent/Guardians - Father & Mother Full Name *
Mother Telephone - Main # for Contact *
Father Telephone - Main # for Contact *
Address *
Local Emergency Contact OTHER than Parent *
Emergency Contact Phone number *
Emergency contact relationship to student *
Person #1 authorized to pick up student and the relationship to student. *
Person #1 telephone contact *
Person #2 authorized to pick up student and relationship to student. *
Person #2 telephone contact *
Person #3 authorized to pick up student and relationship to student. *
Person #3 telephone contact *
Parental Release and Photo consent
Type your name as you would sign
I, the undersigned (as a parent or guardian or the participant, a minor) hereby give permission for mutual exchange of information between Cowboy Academy Summer Programs and the Conrad Public Schools regarding health and safety issues, immunization records and academic achievement. *
For internal use, I acknowledge that the Cowboy Academy Summer Program may utilize film, print, and digital images of a student, which may be taken during involvement in the program activities. I consent to such uses and hereby waive all rights to compensation. *
Medical Information and Release
Type your name as you would sign.
Doctor Name *
Phone number *
Serious Health Problems - please list *
Medications - please list (STAFF WILL NOT MEDICATE CHILDREN. PARENTS/GUARDIANS ARE ENTIRELY RESPONSIBLE FOR MEDICATIONS AND FOR PERSONALLY ARRANGING FOR OR INSURING THE PROPER AND TIMELY MEDICATING OF THEIR CHILD) *
I, the undersigned (as parent, or guardian of the participant, a minor) hereby authorize the staff of the Cowboy Academy Summer Program to consent to medical, surgical, or dental examination and/or treatment. In case of emergency, I hereby authorize treatment and/or care at any hospital or by licensed medical personnel. *
Date *
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Summer Program/Camp Selection
Please check what program/camp you are enrolling for. Clink the link for program descriptions
Summer Program and Camp Descriptions
Select which camps you are enrolling for *
Enroll your child in the program for the grade level that was completed during the current 19-20 school year.
Required
Comments/Other
Please leave any comments or other information that you feel is important for staff to know.
Comments/Other
A copy of your responses will be emailed to the address you provided.
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