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Camper Forms
Jarod Simmons
2019-03-05T22:04:15+00:00
CAMPER REGISTRATION
Camper's Name
*
First
Last
Camper's Age
*
Camper's T-Shirt Size
*
Youth Small
Youth Meduim
Youth Large
Youth X-Large
Adult Small
Adult Medium
Adult Large
Camper's Robotics Experience
*
No Robotics Experience
Some Robotics Experience
Pizza Lunch?
Yes, I would like a pizza lunch to be provided (+$10/d)
Parent / Guardian Information
*
First
Last
Relationship
*
Mother
Father
Guardian
Email
*
Primary Phone
*
Secondary Phone
Emergency Contact
*
Make me the Emergency Contact
Add an Emergency Contact
In case of emergency involving my child, I understand every effort will be made to contact me/us.
Parent / Guardian Information
First
Last
Primary Phone
Relationship
Mother
Father
Guardian
Email
Secondary Phone
Wavier Agreement
*
I have downloaded, read, completely understood, and agree to the
Camp Release & Waiver
.
Medical Agreement
*
I agree that If my child needs medication administered to him/her (including self-administration), I will complete and submit the
Medical Administration Authorization Form
by the first day of camp.
Pizza Lunch Fee
*
I agree that If I have asked for a pizza lunch to be provided, A $10 charge will be assessed from me at the door for each day of camp. If you did not check pizza lunch, no fee will be assessed
Type your Full Name
*
By typing your name in this field you are agreeing that it will be used as an approval or signature and that all of the entered information is correct.
Today's Date
*
Date Format: MM slash DD slash YYYY
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2032 Greenspring Drive Timonium, MD 21093
443-330-7780
info@STAR-Academy.com
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10:00am – 3:00pm
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