Summer Exploration Registration

Participants Last Name
Participants First Name
Email Address
Grade Completed
Age
Parent/Responsible Party
Cell Phone

Select Camp(s) to Attend:


Permission to Treat

Please indicate whether or not you consent as follows:

I hereby give my consent and authorize PROVIDENCE CLASSICAL SCHOOL and its faculty, staff, and coaches to consent on my behalf and on behalf of my child to emergency medical care and treatment in the event I am unable to be notified by reasonable attempts of the need for such emergency medical care and treatment.

Consent to Emergency Medical Treatment

Emergency Contact

If the parents can not be reached, please enter an alternate emergency contact.

Last Name
First Name
Phone
Relationship to Minor

Health Information

Prescription medication (including asthma inhalers and Epipens) will NOT be adminstered by the staff of Providence Classical School without written permission from a parent. Please list any health problems that your child may have and any treatment that may be requried. (i.e., allergies, asthmas, etc.) Any medications furnished by parents, must be in a container labled with the child's name, physician, medication, dosage, route, and time.

Student Health Information

Release of Liability

Please check the box to indicate release of liability as follows:
 

I hereby freely and expressly assume and accept any and all risk of injury and/or death arising from my child's participation in any and all activities my child may undertake by or through PROVIDENCE CLASSICAL SCHOOL.  In so doing, I promise and agree not to make any claim or commence any lawsuit against PROVDIENC CLASSICAL SCHOOL for injuries or damages arising from my child's participation in such activities.  I also acknowledge that I am required to carry and maintain my child's accident and health insurance sufficient to meet all cost and expenses which might incur as a result of any injury my child might sustain while participating in these activities, and by checking the box below, I acknowledge that I am presently covered by such accident and health insurance.

Name of Consenting Adult
Relationship to Minor

Photograph Use Permission

While we may use your child's photograph in a group setting, we will not identify any student by name.

Please indicate below whether or not you give Providence Classical School permission to use your child's individual photograph in its school publications.