Aspiring Nurses and Health Professions Camp 2025

Student First Name

Student Last Name

Student Email

Student Phone

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

T-shirt Size

Sex

Grade Entering in Fall

School

Do you have a latex allergy?

Yes

No

Do you have any food allergies?

Yes

No

If yes, please state food allergies

Other medical concerns/conditions

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

Emergency Contact Name

Emergency Contact Phone

Terms of Participation

I acknowledge the payment is non refundable do you agree to these terms:

Participant Code of Conduct

I will be respectful of all individuals participating in the camp.

I will not use my cell phone during camp class time. Cell phone use will be permitted during breaks.

I will be respectful of all property.

I will conduct myself in a professional manner.

I will adhere to the dress code.

I understand that if the code of conduct is not followed that I may be sent home from the camp.

I have read the terms of participation.

I agree to the terms listed and agree to be photographed/videoed during the event. Photographs/videos may be used for promotional advertising/social media.

Download the attached Photo Release Form and Liability Release Waiver, sign, and upload the signed documents to complete your form submission.
Download General Liability Waiver
Download Photo Release Form

Upload Signed General Liability Waiver

Upload Signed Photo Release