Registration
Release of Confidential Information and Records (required to register for Makin' Waves Camp)
Email address *
I will be sharing information about myself or my child that will be used to support their experience as part of a Berrien RESA sponsored activity. I understand that information about me or my child will also be kept in a database that is subject to confidentiality provisions.
I have read and understand this consent, or had it read to me in a language that I understand: *
Full name of consenting party *
Your answer
Signed by *
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