idea` summer 09 (inventing & designing environmental art)

idea`REGISTRATION FORM pg.2

*Your Youth/Teen's First & Last Name (again) *How I learned about idea` was *A few of the art/game activities my Youth/Teen enjoys are *My Youth/Teen's Date of Birth *My Youth/Teen is (if the option you want is absent, choose other and include info in the notes section of this form.)
Female  Male  Is on active Health Insurance  African American  Caucasian
Native American  Hispanic  Mixed Race  Asian Pacific Islander  Other  *My Youth/Teen is attending this school in the fall *Emergency Contact First & Last Name / relation / phone# *Preferred Hospital (our site cannot distribute medications) *Physician First & Last Name / Business Phone# *I am a legal guardian of this participant & by checking this box I agree to the paragraph below.
yes

Thank you for completing idea`s on-line summer '09 application form! By clicking the submit button you are signifying you have read and agree with details regarding participation, cancelation, fees and expectations and give permission for your Youth/Teen to participate in idea`09, including participation in fieldtrips, photos, video & audio recordings & hereby release idea`/The North Seattle Boys & GIrls Club, its trustees, owners, instructors, staff & volunteers from liability for any injury your Teen/Youth may suffer as a result from participation. Your application will be submitted electronically, and you will receive a confirmation e-mail once your application & registration fee of $80 is processed. For e-inquiries about idea` e-mail idea09.NSBGC@gmail.com. For additional information about idea`, North Seattle Boys & Girl Club's drop-in programs or childcare sites call: 206.784.5396. Thank you for sharing idea`09 with guardians of Youth/Teens you know. We're excited to connect with you soon!