s.t.e.A.m. Learning Journey Application
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* Required
Email
*
Your email
Date
*
MM
/
DD
/
YYYY
Child's First and Last Name
*
Your answer
Mailing Address
*
Your answer
Phone Number
*
Your answer
Date of Birth/Age/Gender/Ethnicity
*
Your answer
Allergies
*
Your answer
Date and Location of Learning Journey
*
Your answer
Child's Learning Style
*
Your answer
Parent/Guardian Information (Including Emergency Contact)
*
Your answer
Parent/Guardian Address (If different from above. Include city, state and zip code)
*
Your answer
Parent/Guardian Phone Number (cell phone) Parent/Guardian Number (work)
*
Your answer
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.
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