Camp Covenant Registration

TO REGISTER FOR ADULT CLASSES, GO TO OUR REGISTRATION FORM HERE.

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 Countries other than the United States or Canada:
State/Province:
Country:
7. * Zip/Postal Code:
8. * Phone:
9. * Email:
10.

Second Parent Name
11.

Second Parent Daytime Phone Number
12.

Second Parent Email

ADDITIONAL HOUSEHOLD

13.

First Parent Name
14.

Address
15.

First Parent Daytime Phone
16.

First Parent Email
17.

Second Parent Name
18.

Second Parent Daytime Phone
19.

Second Parent Email

PARENT INFORMATION

20.
*

Father is deceased
Yes   No
21.
*

Mother is deceased
Yes   No
22.
*

Parents are separated
Yes   No
23.
*

Parents are divorced
Yes   No

EMERGENCY CONTACT INFORMATION

In the event of an emergency, parents or guardians will be contacted first. Please list two alternate emergency contacts.

Emergency Contact 1

24.
*

Name
25.
*

Relationship
26.
*

Daytime Phone
27.

Cell Phone

Emergency Contact 2

28.

Name
29.

Relationship
30.

Daytime Phone
31.

Cell Phone

INDIVIDUALS AUTHORIZED TO PICK UP YOUR CHILD(REN)
Please list all individuals who are authorized to pick up your child(ren), including parents:

32.
*

Name 1
33.
*

Phone
34.
*

Driver's License No.
35.

Name 2
36.

Phone
37.

Driver's License No.
38.

Name 3
39.

Phone
40.

Driver's License No.
41.

Name 4
42.

Phone
43.

Driver's License No.

ADMINISTRATIVE INFORMATION

44.
*

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
45.
*

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.

46.
*

Name
47.
*

Relationship
48.
*

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