Valor Summer Camp Registration Form
Please fill out the following form. (One Form Per Student Please)
Email address *
Student's Name *
Your answer
Student's Date of Birth/ Age *
Your answer
Student's Gender *
Please list any allergies or medical conditions your student has.
Your answer
Please list any medications your student is currently taking.
Your answer
Mailing Address: *
Your answer
Primary Phone Number: *
Your answer
Secondary Phone Number: *
Your answer
Currently Enrolled:
Your answer
Grade for Fall 2018: *
Your answer
Parent/Guardian #1: *
Your answer
Cell Phone: *
Your answer
Parent/Guardian #2:
Your answer
Cell Phone:
Your answer
E-mail Address: *
Your answer
Non-Parent Emergency Contact Name: *
Your answer
Relationship to Student: *
Your answer
Primary Phone Number: *
Your answer
Alternate Phone: *
Your answer
Photo Permission & Media Release:
By checking yes below you are authorizing the use of your student's images &/or videos in school publications and public media.
Photo Permission & Media Release: 6/18/18 - 8/17/18 *
Sign & Date Electronically Below *
Your answer
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