Winter

Waiver

I do hereby give my permission and consent for myself and/or my child(ren) to participate in programs and activities sponsored by GETKD as set forth on this Form. I understand that the activity for which I have completed this Form may involve some risk of injury. I further understand that I and/or my child(ren) is participating at mine and/or his/her own initiative, risk, and responsibility. I have had all my questions answered for me regarding the programs and activities, and I have received full disclosure of what the activities will be from GETKD.

Check All That Apply
*

December 20
December 21
Select a Time
*

From 9 to 2 pm
From 7:30 to 6 pm
Student Name-1
*
Birth date: (MM/DD/YY)
*
Student Name -2
Birth date: (MM/DD/YY)
Student Name -3
Birth date: (MM/DD/YY)
Parent/Guardian’s Name
*
Address
*
- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Phone Number
*
Email Address
*
THE FOLLOWING IS REQUIRED TO BE ATTACHED TO THIS FORM (Parent to check box indicating task is complete)
*

I have read, understood, and agreed to the Liability Waiver form. The above information is true to the best of my knowledge.
EMERGENCY CONTACT NAME
*
EMERGENCY CONTACT Phone Number
*
Date
*

WINTER CAMP

$40.00

for 9 am to 2 pm per student.

$55.00

for 7:30 am to 6 pm per student. (non-refundable)