s.t.e.A.m. Learning Journey Application

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Email *

Date *

YYYY

Child's First and Last Name *

Mailing Address *

Phone Number *

Date of Birth/Age/Gender/Ethnicity *

Allergies *

Date and Location of Learning Journey *

Child's Learning Style *

Parent/Guardian Information (Including Emergency Contact) *

Parent/Guardian Address (If different from above. Include city, state and zip code) *

Parent/Guardian Phone Number (cell phone) Parent/Guardian Number (work) *

Photo Release (I agree for my minor's photo to be taken and used by Thick Descriptions) *

I agree

I disagree

Required

Hold Harmless

If my child's application is approved, by checking the "I understand" box below, I agree to indemnify and hold Thick Descriptions harmless from all losses, liabilities, damages, costs or expenses (including but not limited to reasonable attorneys' fess and other litigation costs and expenses) incurred as a result of any claims or suits that I (or anyone claiming by, under or through me) may bring against Thick Descriptions to recover any losses, liabilities, costs, damages, or expenses which arise during or result from my child's(ren) participation in the Thick Descriptions project, regardless of whether or not caused in whole or part by the negligence or other fault of Thick Descriptions and/or Thick Descriptions staff. In addition, Thick Descriptions staff cannot provide rides for campers and all campers must be picked up on time.

I understand.

Required

Submit

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