Boardroom Leadership Youth Conference - Palomar Mountain August 8-11, 2019
Registration
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E-postadresse *
The Trip of a Lifetime!
Boardroom Leadership Mountain Fun
Date of Birth *
Scholars Full Name *
AGE *
Address *
Home Telephone or Celluar
Scholars Cell Phone Number
Parents Name *
Parent Occupation *
Parents Cell Phone Number if different from above
Emergency Contact (name, address, phone) *
Medical Provider (Physician, Address, telephone)
Medical Record Number (please photocopy front and back) *
Medical Conditions (include food and other allergies)
Prescribed Medication (Dosage info from physician required)
School *
AUTHORIZATION Please type your full name to give consent to administer medication and/or authorize medical treatment. *
Grade this Fall *
Scholar Extra Curricular Activities
Learning Challenges
Behavioral Challenges
Grades *
Obligatorisk
T-shirt Size - Youth $12/ Adult $15 (Mandatory)
Opphev valget
Optional Hoodie (Adult Sizes Only) $40
Opphev valget
Parental Reminders
Medical Prescription and Authorizations
Copy - Front and Back of Medical Card
Permission Waiver and Release
Video and Photography Release
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