Address Line 2:
Phone Number (where you can be reached during the summer):
Emergency Contact First Name:
Emergency Contact Last Name:
Emergency Contact Phone Number:
Please choose your first choice for Counselor Camp.
Please choose your second choice for Counselor Camp.
** 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.