Please indicate camp session(s) at Canyon Creek (1,2,3) and Fernwood (4,5,6) you are registering for:
Dates
/Length
/FULL Day
9:00am – 3:00pm$200 /
½ day
9:00am –12:00pm$100 /
½ day
12:00pm – 3:00pm$100
June 22 – June 26
/5-day session
/□
/□
/□
June 29 – July 1
/3-day session
/□$120
/□$60
/□$60
July 6 – July 10
/5-day session
/□
/□
/□
July 20 – July 24
/5-day session
/□
/□
/□
July 27 – July31
/5-day session
/□
/□
/□
August 3 – August 7
/5-day session
/□
/□
/□
Student Name:
/Grade Next Fall:
Parent/Guardian Name:
Address:
City:
/Zip Code:
Home Phone:
/Emergency Phone:
Email Address:
- I hereby authorize Tim Sullivan to act according to his best judgment in any emergency requiring medical attention.
- I know of no medical or physical conditions that might limit my child’s ability to fully participate in camp.
- I understand that I am responsible for any medical or other costs incurred in connection with my child’s attendance at camp.
- I hereby waive and release the Northshore School District, Tim Sullivan and his employeesfrom any and all liability that may arise out of my child’s participation in this camp.
- I will provide transportation home and will pick my child up by 12:00pm or 3:00pm.
Patient/Guardian signature / Date
Please complete, sign, and send with payment to Tim Sullivan
7573 Old Redmond Road #1, Redmond, WA 98052
“These activities are not sponsored by the Northshore School District or any of its schools. The district assumes no responsibility for the conduct during or safety of the activities. Northshore School District shall be held harmless from any cause of action, claim, or petition filed in any court or administrative tribunal arising out of the distribution of these materials including attorney’s fees and judgments or awards.”