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Participation Permission and Waiver
This form is REQUIRED to participate in
camps and classes produced by She-EO, LLC
- except Girl Scout programs.
Please complete ONE new form every program season (or when your child's information changes). Your child can not participate until this form is completed, submitted and received by our office.
This form does not take the place of forms required by our community partner or site host.
This information is for internal use only and will NOT be sold or shared with third parties without the user's permission.
Email contact@sheeoacademy.com or call 866-697-4336 if you have any questions.
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* Indicates required question
How (or where) did you register for this camp?
*
Choose
Fairfax County Park Authority
Arlington County Parks & Recreation
Loudoun County Parks, Rec and Community Svc
Tidewater Community College
6crickets.com SheEO Academy
Active com SheEO Academy
What is the START DATE of your camp or class?
*
MM
/
DD
/
YYYY
Participant's First and Last Name:
*
(Your child's name. Please do not submit more than one child per form.)
Your answer
Enrolling parent's First and Last Name:
*
Your answer
Enrolling parent's Mobile Phone Number:
*
Your answer
Enrolling parent's Home Phone Number:
*
Your answer
Enrolling parent's Home Address: Street, City, State, Zip Code
*
Your answer
What is the enrolling parent's occupation?
*
(no org names needed)
Choose
Business owner (small business)
Business owner (large business)
Physician
Lawyer
Teacher
Business manager
Technology professional (hardware)
Technology professional (software)
Other (please list below)
Other profession not listed above
Your answer
What is the enrolling parent's age range?
*
(no org names needed)
Choose
20-29
30-39
40-49
50-59
60-69
70-79
80-89
Emergency Contact Person's First and Last Name
*
(different from the enrolling parent)
Your answer
Emergency Contact Person's Phone Number:
*
(different from the enrolling parent)
Your answer
Person(s) NOT authorized to pick up your child:
Your answer
Does the participant have ANY allergies (food, environment, etc)? Please list below.
NOTE: The participants may touch glycerin if attending the soap business camp.
Your answer
Does the participant have any special needs or abilities? (hearing aid, dyslexia, gifted, ADHD, etc.) Please list below.
Your answer
Where will the participant attend school in the fall (in Virginia)?
*
Choose
Fairfax County Public School
Arlington County Public School
Loudoun County Public School
Other Northern Va Public School System
Private School Northern Va
Va Beach City Public School
Chesapeake City Public School
Suffolk City Public School
Norfolk City Public School
Other Hampton Roads Public School
Private School Hampton Roads
Homeschooled Participant
She will not attend school in Virginia
What is your child's T-SHIRT size?
*
Choose
youth small (6-8)
youth medium (10-12)
youth large (14-16)
youth extra large (18-20)
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