Registration

Student / Parent Phone

Grade Rising

Session/s Enrolled

Session 1 Session 2 - Girls Only Session 3

Known Allergies (food, medications, etc.)

Dietary Restrictions

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

Choose your student Shirt Size

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.