Archaeology Camp – Historic Kenmore and George Washington's Ferry Farm

Child's Name *

First

Last

Child's Date of Birth *

Gender *

Male
Female

Parent's Name *

Address *

Telephone number *

Email *

School *

Please check which camp you wish to attend *

Archeology Day Camp (age 6-8) July 29-30 at Ferry Farm $50
Archeology Camp (age 9-12) July 13-17 at Ferry Farm $125

Contact Person During Camp Week *

Relationship to camper *

Contact telephone number *

Contact Cell Phone *

Have or Subject to: *

Asthma
Seizures
Bee sting allergy
None of the above

Food or other allergies (please specify):

Any significant medical condition we should know about?

Any restictions from activities?

Any accomodations needed by camper?

I agree with the Photo Release for my camper. *

Yes
No

I hereby give Archeology Camp the absolute right and permission to publish, copyright, and use pictures of my child in which he/she may be included in whole or in part, composite or retouched in character or form. I understand that signing this release does not guarantee publication of a photo.

Digital Signature *

The parties agree that electronic signatures will be permitted under the provisions of the Virginia Uniform Electronic Transactions Act, Va. Code § 59.1-479 et seq. Please digitally sign.

Please list any other restrictions on photography:

The following persons are authorized to pick up the camper. (ID will be checked at pick up) Name/Relationship/Cell #

Name/Relationship/Cell #

How did you hear about this camp?

I certify that all statements made by me on this application are true and complete to the best of my knowledge. My camper has permission to engage in all activities. *

I acknowledge that I have read the above statement and understand the same.

Digital Signature *

The parties agree that electronic signatures will be permitted under the provisions of the Virginia Uniform Electronic Transactions Act, Va. Code § 59.1-479 et seq. Please digitally sign.