Together We Camp Registration Form
Email address *
Parent Name *
Your answer
Parent Phone *
Your answer
Parent Email *
Your answer
Names of Camp Participants in Your Household (First and Last Name, Age) *
Example: Annabelle Jackson, 8; Charlie Jackson, 10; Demonte Jackson, 11
Your answer
Where are you located (City, State)? If you are in Chicago, what school(s) do you attend? *
Your answer
How did you hear about our camp? *
Select all weeks you plan to attend ($100 each week) *
Required
LIABILITY WAIVER (SIGN WITH FIRST AND LAST NAME) *
I, the parent or legal guardian of the above-named student(s), a minor, understand that my child will be participating in an array of activities, including but not limited to, yoga, dance, cooking, fitness challenges with Together We Camp. I recognize and acknowledge that there are certain risks of injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. In consideration of being permitted to participate in Together We Camp sessions, I, for myself and the student and our respective heirs, administrators and legal representatives, intending to be legally bound, hereby release and indemnify Together We Camp, its owners, and instructors from and against all claims, liabilities, damages or causes of action, present or future, whether known, anticipated or unanticipated, arising out of or in connection with my child’s participation in the classes, whether caused by negligence or otherwise. I understand the conditions and terms of this agreement. I consent to the conditions and terms listed in the liability waiver (above)
Your answer
MEDIA WAIVER (SIGN WITH FIRST AND LAST NAME) *
I am the parent/legal guardian of the child(ren) named above, who is under the age of 18. I hereby give permission to Together We Camp and its agents to include certain personal information about my child/ward in connection with support of Together We Camp including publication in: Promotional materials, press releases, newsletters, web site contents, and in all media now known or hereinafter devised in perpetuity. I understand that this media will be accessible throughout the world and that stories including my child/ward’s personal information may appear in written, video, electronic, and other forms. I understand that information provided by me on child/ward will be used to promote Together We Camp and its providers. I release Together We Camp's agents and employees from any claims of infringement, invasion of privacy, defamation or misappropriation arising from the use of the information provided by me in the permitted manner. I understand the conditions and terms of this agreement. I consent to the conditions and terms listed in the media release.
Your answer
Payment Method *
Each week of camp costs $100 per family. After you submit this form, remit payment for the number of weeks you plan to attend. Electronic payments ONLY. Your registration is not complete until payment is rendered.
Required
A copy of your responses will be emailed to the address you provided.
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