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Register Here:
First Name
Last name
Student / Parent Phone
Email
Birthday
Age
Grade Rising
8th
9th
10th
11th
12th
Session/s Enrolled
Session 1
Session 2 - Girls Only
Session 3
Emergency Contact
Emergency Phone
Emergency Email
Known Allergies (food, medications, etc.)
Dietary Restrictions
Gluten Free
Kosher
Halal
Vegan
Vegetarian
Other Dietary Restrictions
Pertinent Current Medications (if any):
Pertinent Medical Conditions (if any):
Does your teen have any special needs or accommodations we should be aware of?
Is there any other information you would like to share with us to ensure a positive camp experience for your teen?
Primary Physician's Name:
Physician's Contact Number
How will the student travel home?
Driving
Pick-Up
Another Student
Other
Authorized Pick-Up Person: 1
Authorized Pick-Up Person:2
Authorized Pick-Up Person:3
Photo/Video Release: I give consent for my teen's photo/video to be taken during camp actvities for promotional purposes.
Yes
No
Siblings Enrolled
Choose your student Shirt Size
Extra Small
Small
Medium
Large
Extra Large
2X
3X
By signing this form, I certify that all information provided is accurate and complete to the best of my knowledge. I understand that this information will be used for the purposes of organizing and ensuring the safety of my teen during their participation in the camp activities at I Present.
Date
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