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Cub Camp Application

The document is an application for Marshall Middle School's Catamount Cub Camp for rising 6th graders from June 3rd to June 27th. It provides information about camp hours, fees, and dates and includes sections for applicants to provide family, medical, and emergency contact information as well as permissions for activities and photography. Parents can find additional applications online or by calling the provided number.

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49 views2 pages

Cub Camp Application

The document is an application for Marshall Middle School's Catamount Cub Camp for rising 6th graders from June 3rd to June 27th. It provides information about camp hours, fees, and dates and includes sections for applicants to provide family, medical, and emergency contact information as well as permissions for activities and photography. Parents can find additional applications online or by calling the provided number.

Uploaded by

api-248885941
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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MARSHALL MIDDLE SCHOOL

ACADEMY OF FINE ARTS


Catamount Cub Camp Application
8:00am-3:30pm
CAMP FEE-$15.00
(Fee includes: Camp T-shirt & Fieldtrips)
th
Camp age: 5 graders entering 6th grade
Camp Dates: June 3rd June 27th
Camp Hours: 8:00am-3:30pm Monday through Friday

APPLICATIONS
ARE DUE BY:
MAY 31, 2014

Family Information:
Childs Name_______________________________________ Grade Entering in fall: __________ Age: ___________
Birth Date: _________________________________________ Gender: ______________
Address: ___________________________________________ City: ___________________ Zip: _________________
Telephone #:_______________________________________
Mothers Name: ____________________________________ Mothers Work Phone: _________________________
Mothers Cell Phone: ________________________________ Email: _______________________________________
Emergency Contact: Yes

No

Authorized Pickup: Yes No

Fathers Name: ____________________________________ Fathers Work Phone: _________________________


Fathers Cell Phone: ________________________________ Email: _______________________________________
Emergency Contact: Yes

No

Authorized Pickup: Yes No

Medical Information:
Chronic Illness (asthma, seizures, diabetes, etc.):_________________________________________________
Prescription Medicines: ______________________________________________________________________
Allergies: __________________________________________________________________________________
Dietary Restrictions (must be accompanied by a physicians note):
__________________________________________________________________________________________
__________________________________________________________________________________________

Applications can also be found on our website


www. Marshallcatamounts.org or call 713-226-2600
For information

Emergency and Pick Up Authorization:


Persons to be contacted in an emergency if I/we cannot be reached and persons authorized to pick up my child
from Catamount Cub Camp. (If you have more than two please attach a separate sheet of paper)
1. Name: ____________________________________ Relation: ____________________________________________
Work Phone: ______________________________ Cell Phone: __________________________________________
Additional Phone: ___________________________ Emergency: Yes

No

Pickup: Yes No

2. Name: ____________________________________ Relation: ____________________________________________


Work Phone: ______________________________ Cell Phone: __________________________________________
Additional Phone: ___________________________ Emergency: Yes

No

Pickup: Yes No

Student information:
T-Shirt Size (circle one):
Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

I station username___________________________________ Password _______________________________

Emergency Authorization:
I/We hereby authorize the care of my child during the hours of operation of the Catamount Cub Camp. The
information that I have provided should be used in the event of an emergency.
Parents Signature_____________________________________________ Date: _________________________

Water Day Authorization:


I/We give my/our child permission to participate in water day activities
Parents Signature_____________________________________________ Date: _________________________

Media Authorization:
I/We hereby give the facility permission to photograph my/our child during summer camp activities. I also give
permission for them to be published in the local newspaper, district newsletter or our school website.
Parents Signature_____________________________________________ Date: _________________________

Parent Volunteer Information: (check all that apply)


I am interested in volunteering

I am interested in chaperoning for fieldtrips

I am a registered HISD VIPS

Visit our website


Www. marshallcatamounts.org or call 713-226-2600
for more information

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