* indicates a required answer.
We kindly ask that you complete a separate registration for each child. This insures we have the required registration information for each child and helps us clearly understand which camp days your child wishes to attend. Space is limited and registrations will be accepted in the order for which they are received. Once we process your registration we will send you an invoice for payment. Registrations are managed on a first come, first served basis. Registrations are considered complete and space reserved AFTER payment has been received. In the event that classes become full, you will be placed on a waitlist. All waitlist individuals will be notified of availability no later than May 20, 2018.
Parent's First Name
Parent's Last Name
Parent's Phone #1 (primary number for emergency contact):
Parent's Phone #2 (secondary number; please enter NONE if you do not have one):
Member Status (please check ONE box):
Child's First Name:
Child's Last Name:
Please mark desired camps:
Sibling Discount: Have you registered a sibling for a camp?
If yes, please provide the name of the sibling(s):
CONSENT TO PARTICIPATE & HOLD HARMLESS AGREEMENT:
I, parent/guardian, do hereby grant permission for the above named child to participate in this event/activity. In consideration of my child’s participation, I agree to indemnify and hold harmless Nebraska Homeschool – The Home Educators Network, Inc. (NH-HEN), Heartland Home Schoolers (HHS), and their volunteers, from any and all liability or claims brought by anyone, including, but not limited to claims related to use of the venue.
PHOTO & IMAGE RELEASE FOR PARTICIPATING ADULTS & MINOR CHILDREN:
Nebraska Homeschool (NH-HEN) and Heartland Home Schoolers (HHS) have my permission to use photographs, images or likeness of me and/or the named minor children and our names, for use in their media (printed publications, social media outlets, and website) in relationship to its mission and homeschooling. I acknowledge that participation in said media produced by NH-HEN and HHS confers no rights of ownership and that no royalty, fee or compensation will become payable to me or the named minor children and release NH-HEN and HHS from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children. I release the NH-HEN and HHS from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed above and that I have the authority to authorize use their photographs, images or likeness and names.
EMERGENCY MEDICAL TREATMENT:
In the event of an emergency, I give permission to activate the Emergency Medical System (EMS) and if necessary, to transport my child to a hospital via the EMS while under the care of licensed medical personnel. I am to be immediately contacted at the phone numbers listed above.