HHS HI-STEPPER KIDDIE CAMP

Registration Form

July18– 21,2017

HHS Gym, 9AM- noon (Doors open at 8:00)

PLEASE PRINT CLEARLY:

Participant's Name: ______Age: ______

Mailing Address: ______

Phone Number: ______Email Address: ______

Emergency Contact: ______Phone#: ______

Known Allergies: ______Medical Conditions: ______

Days Attending Camp: Tuesday, July 18  Wednesday, July 19 Thursday, July 20 Friday, July 21

Cost:

$60/week (includes t-shirt, buddy picture, group picture, and snack)

Please check individual day(s):  Tues., July 18  Wed., July 19 Thurs., July 20  Fri., July 21

T-Shirt Size: Youth X-Small  Youth Small  Youth Med  Youth Large  Adult S  Adult Med

Make checks payable to HHS.

Complete this form, and mail or deliver it with your payment to:

Hahnville High School, Attn: Robin Valdin, 200 Tiger Drive, Boutte, LA 70039

Parental Release and Indemnity Agreement

I hereby request that you accept the enrollment of ______in the Hahnville High School Hi-Stepper Kiddie Camp on July18 – 21, 2017. In consideration of this application, I hereby release Hahnville High School and its employees from all claims on injuries which may be sustained by my child while attending the Hahnville High School Hi-Stepper Kiddie Camp, and I agree to indemnify Hahnville High School and its employees for any claim which may hereafter be presented by my child as a result of such injuries.

In the event that I am unavailable for purposes of providing parental consent, I authorize the staff, hospital, or emergency care center affiliated with Hahnville High School to provide such hospital care that includes routine diagnostic procedures and medical treatment as necessary to my minor child. I understand that consent does not include major surgical procedures and is only valid during the dates of the camp.

______

Signature of Parent/Guardian Date

PLEASE NOTE:

  • Gym doors will not open each morning until 8:00 AM.
  • Ribbon Order Form on the back! Ribbon Order: yes or no (circle one)
  • Picture Order Form on the back!Picture Order: yes or no (circle one)

Ribbon Pre-Order Form

($3.00 for 1; $5.00 for 2; $7.00 for 3)

Ribbon #1:

Ribbon Color (Circle One): PurpleGoldWhiteBlack

Side 1 (Circle One):HHSDance TigersFirst Name

Side 2 (Circle One): Paw PrintsSwirls Dots Chevron

Ribbon #2:

Ribbon Color (Circle One): PurpleGoldWhiteBlack

Side 1 (Circle One):HHSDance Tigers First Name

Side 2 (Circle One): Paw PrintsSwirls Dots Chevron

Ribbon #3:

Ribbon Color (Circle One):PurpleGoldWhiteBlack

Side 1 (Circle One):HHSDance Tigers First Name

Side 2 (Circle One): Paw PrintsSwirls Dots Chevron

PICTURE ORDER (Every Child will Take a Picture)

Pictures will be taken on Wednesday, July 19!

NAME______AGE:______

Hi-Stepper Buddy______(Camp will fill out)

Special Instructions______