Name: Virtual Camp CARE
Start: 2020-07-20T10:00:00+00:00
End: 2020-07-31T14:30:00+00:00
Location: The Comfort of Your Own Home!

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Parent Guardian Information
Parent/Guardian Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
How did you hear about the camp?

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Emergency Contacts
List two different people that could be contacted in case of an emergency.
Emergency Contact #1 Name
First Last
Contact #1 Relationship to Child
Emergency Contact #1 Phone
Emergency Contact #2 Name
First Last
Contact #2 Relationship to Child
Emergency Contact #2 Phone

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Family Information
The following questions will have a follow-up call to complete registration.
How Many Times Has Your Family Moved?*
Have you moved within the last 12 months?*
- Yes
- No
Has there been divorce/separation in the family?*
- Yes
- No

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Consent
I give permission for my child/children to participate in the CARE Summer Leadership Camp in ---. I understand that my child will be required to complete a pre/post evaluation for the camp and that the purpose of this evaluation is to help CARE staff demonstrate that the program is effective and impactful for the participating youth. I grant CARE of Southeastern Michigan the absolute and irrevocable right and unrestricted permission concerning the use of photographs that may be taken which may include with others, to use, reuse, publish, the photographs in whole or in part, individually or in connection with other materials. I release and discharge photographer from any and all claims that may arise out of or in connection with the use of the photographs, including without limitation any and all claims for liable or violation of any right of publicity or privacy.
Name
First Last
Date
MM slash DD slash YYYY
Would you like to join our mailing list?
- Yes
Consent
I agree to the privacy policy.

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Virtual Camp CARE

Details