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Montessori Summer Camp Registration and Medical Release (2022)

Please submit one form for each camper you are registering.

Email^*

Enter email again^*

Student First Name^*

Student Last Name^*

Camp week(s) you are registering for

Grade entering (Fall 2022)^*

School your child currently attends^*

Parent/Guardian Address

Address Line 1

Address Line 2

City

State or Region

Country

Zip

Parent/Guardian Email(s) for camp correspondence^*

Parent/Guardian Name and Phone Number^*

Additional Parent/Guardian Name and Phone Number

Physician Name and Phone Number^*

Current Medications

Allergies

Other

I authorize HPMP, Helena School District, and its representatives to secure medical attention and care in the event of illness or accident for the above named child. In case of emergency, I understand that you will contact me as soon as possible. Permission is also granted to the doctor or the hospital and their associates to perform emergency medical and surgical procedures if needed.I also understand that photographs or other digital media may be used during summer camp to record the camp experience. I hereby allow HPMP to utilize photographs or digital media of my child for promotional summer camp materials such as brochures, presentations, or on the HPMP website.

Parent Signature: Your name entered below will be considered your permission and understanding signature authorization.^*

Camp Selection and Payment

Which camp(s) would you like to attend?^*

Select a payment method^*