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First Name:
*
Last Name:
*
T-shirt size:
*
Adult small
Adult medium
Adult large
Adult XL
Adult XXL
Adult 3XL
Adult 4XL
Street Address:
*
Address Line 2:
City:
*
State:
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code:
*
Phone Number (where you can be reached during the summer):
*
Email Address:
*
Emergency Contact First Name:
*
Emergency Contact Last Name:
*
Emergency Contact Phone Number:
*
Please choose your first choice for Counselor Camp.
*
Diesel
Machine Tool
Computer-Aided Drafting
Please choose your second choice for Counselor Camp.
*
Diesel
Machine Tool
Computer-Aided Drafting
** Please note: In shop-related camps, jeans, t-shirts, and closed-toe shoes will be required by all participants. Absolutely no tank tops, shorts, sandals, or flip flops are allowed. Long hair must be pulled back, and no jewelry is allowed. It is likely clothing may get dirty; please choose appropriately. Other protective gear will be provided on-site.
Do you have any food allergies, physical limitations, or health concerns we should be aware of for your safety?
*
Do you give Salina Tech permission to use or release to local media outlets your picture or video of you at camp in Salina Tech media and for release to media outlets in print or electronic/digital fashion?
*
I permit my picture or video clip to be used.
I do not permit my picture or video clip to be used.
This signature acknowledges the participant's understanding of the dress code for personal protective clothing required for camp participation specific to his or her camp area of participation and activities.
In addition, in the event of an injury, the emergency contact will be notified. If necessary, the participant will be taken to the nearest hospital. The payment of medical bills related to the accident or injury will be the responsibility of the participant.
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