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I. Participant Information: Use a separate form for each applicant.
Girl
Boy
Age:
Name:
Nickname:
Date of Birth (mm/dd/yy): Current Grade (2011-2012):
Address:
City:
State:
Zip:
Home phone
Family Email:
All GBC materials will be sent by email.
II. Getting to Know You:
A.
Since most of our activities require team participation, please check the area(s)
in which you feel you have ability/skill and could contribute to the team
OR just tell us what you like to do!
Acting
Script Writing
Prop Construction
Mechanical Wizardry
Artwork
Music
Other; please list them here:
B. Have you ever spent 5 days away from home or at an overnight camp?
Yes
No
Did you have fun?
Yes
No
Tell us about it:
C. Creative Problem Solving Experience (Odyssey of the Mind, Destination ImagiNation, etc:
Odyssey or DI - # years:
Other
Not Yet!
III. T-Shirt Size:
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Other:
IV. Parent/Guardian Information:
GottaKid resides with:
Both parents
Mother
Father
Father's name:
Daytime phone: -
-
Mother's name:
Daytime phone: -
-
V. Physical/Health Concerns:
Does your child have any physical conditions or health issues (i.e. asthma, hearing impairment, etc.), require special services during the school year or are there other concerns of which the staff should be aware? If yes, please explain briefly at this time.
No
Yes
Please explain:
VI. The Small Print:
I have read and approved the following:
I authorize GottaBeCreative to use still and/or video photographs of my child to promote this program.
I understand that GottaBeCreative is not responsible for my child’s personal property.
I understand that the program medical form MUST be submitted prior to my child beginning GBC, and that it will include significant health or medical information. All participants are required to show proof of medical insurance coverage and SUBMIT a copy of their health card and parents MUST sign GBC's emergency release form.
In case of cancellation before May 15, 2012, the deposit will be kept and the balance of registration fee will be returned. After May 15, 2012, there will be no refund.
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