Camp Covenant Registration for Adult Classes

Step 1 of 4

* indicates a required field
1. * First Name:
2. * Last Name:
3. * Mailing Address Line 1:
4. Mailing Address Line 2:
5. * City:
6. * State/Province & Country: For the United States or Canada:
For Countries other than the United States or Canada:
State/Province:
Country:
7. * Zip/Postal Code:
8. * Phone:
9. * Email:

EMERGENCY CONTACT INFORMATION

In the event of an emergency, please list two alternate emergency contacts.

Emergency Contact 1

10.

Name

11.

Relationship

12.

Daytime Phone

13.

Cell Phone

Emergency Contact 2

14.

Name

15.

Relationship

16.

Daytime Phone

17.

Cell Phone

ADMINISTRATIVE INFORMATION

18.
*

How did you learn about Camp Covenant?

(1 required)
Camper is a current Covenant student/parent   Camper is a former Camp Covenant camper
Covenant alumni   Friend
The Covenant School website   Online ad
Print ad   Other
19.
*

Would you like to receive information about the The Covenant Admissions process?

(1 required)
Yes   No

CONSENT FOR USE OF PHOTOGRAPHY AND STUDENT WORKS
I give consent to allow photographs, videos, voice recordings, written or artistic extractions of student work, to be used in whole or in part, for any school publications, marketing materials, websites, or any school internet posting. Camp Covenant participants are occasionally asked to be a part of school publicity, publications and/or public relations activities. Upon enrollment in Camp Covenant, your camper's name, voice, photos, videos, work and verbal statements may appear in school publicity or publications, videos or on Covenant's website. For example, pictures and articles about school activities may appear in local newspapers, school brochures, or social media sites such as, but not exclusive to, Instagram and Facebook. These pictures and articles may or may not personally identify the student. If you wish to opt out of this consent, you must submit your request in writing to the school.

AUTHORIZATION AND ACKNOWLEDGMENT
I state that I have financial and legal responsibility for the student named in this Registration Form. By signing below, I agree to all consents, authorizations, and permissions described within this Registration Form.

20.
*

Name

21.
*

Relationship

22.
*

Date

 
23. Number Attending: You will be able to enter the names on step 2.