JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Hosted by the College of Health Sciences at EKU
Please read the information packet in its entirety before completing this registration form. Camp will be June 13 - 16, 2022 from 9a.m. - 3p.m. daily.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Desired Name tag name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
School last attended
*
Your answer
Parent/guardians name
*
Your answer
Home address
*
Your answer
Parent guardian phone number
*
Your answer
Parent guardian email address
*
Your answer
T shirt size
*
Your answer
Food allergies
*
Your answer
I understand my campers medical information will be collected on the Health History page I must fill out and sign.
Choose
Option 1
Option 2
I understand that my camper will not be allowed to stay at camp on the first day if they do not have the following: select each one so we are aware you know of the forms necessity.
*
Waiver of Liability, Assumption of Risk and Indemnity Agreement
Student Pick Up Authorization Form
Photographic Consent and Release Form
Health History and Parent Consent Form
Emily's Yoga LLC Liability Waiver
My camper, and I, have read and understand the Cell Phone and Electronics Policy for E4 Girls Health Camp.
*
We understand and will abide by the policy set forth for cell phone and electronic use during E4 camp.
I understand my campers spot is not secure until I remit payment via the EKU Marketplace website
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Eastern Kentucky University.
Report Abuse
Forms
