Middle School Summer Program Registration
Entering 7th & 8th grade

Time: 9:30 am – 3:30 pm (Drop off as early as 9:00 am). Culminating event for friends and family on Friday, July 12th from 4 pm – 6 pm

Light snacks will be available, please bring a sack lunch and water bottle.

Cost: $250 - Pay here:

https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=AGQR826NYVD66&source=url

*Full and partial scholarships available, contact Suzie Staley at suzie@neutral-zone.org*

Email address *
Teen First Name *
Your answer
Teen Last Name *
Your answer
Teen Email
Your answer
Teen Phone Number
Your answer
Teen Address
Your answer
Teen Date of Birth *
MM
/
DD
/
YYYY
Parent 1 First and Last Name *
Your answer
Parent 2 First and Last Name
Your answer
Parent Email *
Your answer
Parent Phone Number *
Your answer
Parent Address *
Your answer
Grade Teen is Entering Fall 2019 *
School Teen will be Attending *
Your answer
Emergency Contact Name (Not Parent) *
Your answer
Emergency Contact Phone Number *
Your answer
Any Known Allergies? (Food/Medication)
Your answer
Medication List
Your answer
Program teen would like to attend *
I give full permission for Neutral Zone to use any photographs, films and/or sound recordings in which my child appears for publicity purposes, now and any time in the future, in any media. *
I hereby grant permission to Neutral Zone staff to perform basic first aid on my child and secure or administer other such emergency medical treatment as staff deem necessary. I understand that in case my child becomes ill or injured, parents, then emergency contact persons will be called immediately for their decision on medical treatment. If the parents or emergency contact listed are not immediately reachable, or if in the opinion of Neutral Zone staff the situation requires emergency action, NZ staff will use their judgment as to what medical treatment is appropriate. *
A copy of your responses will be emailed to the address you provided.
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