TRANSCEND CAMP REGISTRATION

Student Name*

Date Of Birth*

School*

Address*

Zipcode*

Parent's Phone*

Student's Email

Parent's Email

Select Camp

Start Dates Jun 17Jul 15Aug 12

1st Parent/Guardian

Cell Phone

Place of Work

Work Phone

2nd Parent/Guardian

Cell Phone

Place of Work

Work Phone

 Emergency Contact 
 Relationship 
 Telephone 
 Cell Phone 

Name and phone number(s) of person(s) other than parents allowed to pick up your child

Phone

Any special instructions, such as custody or restraining orders must be attached to this application and discussed personally with the camp director. All information will be kept confidental.

Please list any other information you’d like to include about your camper:

Parent Authorization Form

Please print all information clearly

Name of Camper:

Today's Date

Transcend STEM Education does not discriminate on the basis of race, color, sex, handicap, religion or national origin. Transcend STEM Education reserves the right at its sole discretion to refuse an application or dismiss a child from camp. No refund will be made of fees if the child has attended any portion of the camping period.
I understand and accept these guidelines

Parent/Guardian's Signature: By typing my name and submitting I consent that this constitutes my electronic signature and that I have read and understood the terms and conditions on this form and if I have made a payment for services referenced herein my signature serves as authorization to that payment.

I give Transcend STEM Education permission to photograph and/or videotape my child for public relations and/or marketing purposes. Photos will remain archived at Transcend STEM Education and can be used for promotional purposes without notification.

I give permission for Transcend STEM Education to transport my child off camp property for the purpose of field trips and/or medical care. I understand that a schedule of events will be available to me and that all events are subject to change due to weather and/or scheduling conflicts without notice.

I authorize the camp management to act as the agent of the parents in any emergency situation or to administer basic first aid for the health and welfare of the camper involved. I am responsible for the expenses involved if the services of a physician or hospital are required. Please request a waiver for persons requesting exemption from medical treatment.

Hospital Preferred

By signing below I agree to adhere to all the Policies and Procedures set for by Transcend STEM Education Scholarship Application

Student’s Medical Information Form

Please print all information clearly

The medical background of each camper is required as part of the camp’s registration process. The camp director must be advised in writing of any condition that would limit the camper’s ability to participate in any program

Child’s Name:

Date Of Birth

Child’s Pediatrician’s Name

Phone Number

Date of last physical

Date of last tetanus shot

Medical conditions

List of past medical treatments

List all current medications regardless of whether it needs to be taken a camp or not:

Will your child need to take any prescription medications while at camp? YesNo

If yes, please request a medical dispensing form. Return the form and medication in a ziplock bag with your child’s name on it on the first day that they attend camp.

Allergies: (Please put N/A if your child does not have an allergy)

Food

Medication

Insect

Other

Does your child require an Epi-pen? YesNo

If yes, you must provide the camp with an Epi-pen to be kept at camp during your child’s enrollment. Epi-pen must be accompanied with a current prescription and a doctor’s note.

Specific Activities to be restricted for health reasons: