Circus Cascadia Summer Camp Registration Form 2017

Please fill out this form to begin the registration process.
Payment options: Please pay a deposit or full amount to hold your child's spot in the camp.
Please do this right when you finish sending this form to assist easy admin.
Pay using Paypal button on website.
Checks may be sent to:
Circus Cascadia, 8563 SE 257th Ave, Gresham, OR, 97080
A non-refundable deposit of $50 is required to reserve a spot in camp.
All other payments can be completed on first day of camp
You can also email info@circuscascadia.org to arrange payment.
Email address *
Mask Circus Camp 2016
Student Name *
Your answer
Age and Grade level *
Your answer
What camp are you signing up for? *
Sellwood and Peninsular park camps are booked through Portland Parks and Rec .Call 503 823 3195 for Sellwood and (503) 823-3620 for Peninsular Park
Parent or Guardian #1 *
Your answer
Contact Number for Parent/Guardian *
Your answer
Email address *
Your answer
Parent or Guardian #2 *
Your answer
Contact No. *
Your answer
Email address *
Your answer
I give my permission for photographs and/or other forms of media to be used for program documentation without compensation to my child or myself. I understand no names will be used in these publications. * *
Required
Consent for emergency care: I hereby grant permission to Circus Cascadia teachers to perform emergency care, including first aid and CPR on my child and transport my child as deemed necessary for further medical treatment in the event I am unable to be contacted. I further consent to medical or surgical treatment by any licensed physician and or hospital and the administration of surgeries and any other medical treatments deemed necessary or advisable in the event I am unable to be contacted. signed: *
Your answer
Circus Cascadia T shirts are available for an additional $15
Let us know your quantity and size requirements
Your answer
How did you hear about us? *
Your answer
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