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Election Day Camp - Nov 2023
Parent/Guardian Name
*
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Phone Number
*
Email
*
Verify Email
*
Would you like to begin receiving our weekly email newsletter?
Yes
How did you find out about this camp at Awbury?
Election Day Camp 11/7/23
Quantity
$40
-
Regular fee
0
1
2
2
$10
-
Scholarship fee (please get approval first)
0
1
2
2
Child 1's Name
*
First Name
Last Name
Child 1's Pronouns
*
For example: he/him; she/her; they/them
Child 1's age as of Nov 2023
*
Child 1 lunch options
*
select one
Beef hot dog
Turkey hot dog
Vegan hot dog
Will bring their own lunch
Child 2's Name
First Name
Last Name
Child 2's Pronouns
For example: he/him; she/her; they/them
Child 2's age as of Nov 2023
Child 2 lunch options
select one
Beef hot dog
Turkey hot dog
Vegan hot dog
Will bring their own lunch
Child(ren)'s Physician's Name
*
Physician's Phone Number
*
Health Insurance Provider
*
Health Insurance Policy Number
*
Medications Currently Used
*
Illnesses, Medical Conditions, or Allergies
*
Medical Care Consent
*
I do hereby consent to any medical care and the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child is under the care of Awbury Arboretum and I am not reasonably available by telephone to give consent. I am the lawful guardian of the child listed and there are no court orders now in effect that would prohibit me from conferring the power to consent upon another person.
Agree
Do not agree
Is there anything special about your child(ren)'s learning style or physical abilities that you would like to share with us?
Please list who has permission to pick your child(ren) up:
*
Emergency Contacts - Phone numbers and relation to child(ren):
*
Photo Release
*
Photographs taken of my registered child may be used in Awbury exhibits, published in local news outlets and in Awbury publications, or published on the Awbury website or other digital media.
I agree and give photo release permission
I disagree and do not give photo release permission