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Registration Form: please use separate registration form for each camper! Camp attending: (please check) _____9th-12th Grade (8:00 – 10:00 AM) _____7th-8th Grade (10:30 – noon) _____4th-6th Grade (1:00 – 2:30 PM) Camper’s Name:_________________________Phone #:________________________ Emergency contact information: Name_____________________________Phone #:________________ Relation to camper: ________________________ I approve of my child’s participation at the VB101 Basic Skills Summer Camp, and hereby certify that she/he is able to participate in all camp activities. WAIVER OF LIABILITY: In and for consideration of my child’s participation in this camp, I hereby agree and promise that I will not hold Krista DeGeest, the hosting school district, or any camp staff responsible for any loss, damages, or personal injuries that she/he may receive as a result of participation. I have given any special limitations and hereby grant permission to the camp staff to secure proper treatment for my child. Parent/Guardian signature: ____________________________________________ Date:______________ 

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