test Transracial Journeys Family Camp 2021 Registration Family Information Last Name * The last name provided in this field will be the default last name used, but will be editable in subsequent fields Contact Information Address * Address Street Address line 1 Street Address line 1 Street Address line 2 Street Address line 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Primary Phone Number * Alternate Phone Number (optional) Email Address * Alternate Email Address (optional) Participants Parent Information Use the Add/Remove buttons to include additional parents Adult First name * Adult Last name * plus1 Add Adult minus1 Remove Child Information Child First name * Child Last name * Adopted? * Yes No Birthdate * Grade in School, Fall 2021 * -Select One-Infant/Toddler/Not in SchoolPre-School/Pre-KK1st2nd3rd4th5th6th7th8th9th10th11th12th Gender My Child Identify As * plus1 Add Child minus1 Remove Dietary Restrictions Does anyone in your family have dietary restrictions or allergies? None Vegetarian Vegan Kosher Gluten Free Specific Allergies/other Dietary Restrictions, details (please list number of adults and children with given restrictions) For each restriction noted above, list numbers of children and adults Special Requests Additional Comments or Requests Permission to Include Contact Information * Address Primary telephone number Email (A participant contact list will be distributed to all families. Indicate which of the following we may include, checking all that apply.) Cancellation Policy Cancellation/refund policy and deadlines I have read the cancellation policy and understand it. Cancellations made on or before April 15th will be entitled to a full refund, minus a $25 administrative fee. Cancellations between April 16th and June 1st will recieve a 50% refund of the total fees due. There will be no refunds for cancellations after July 1st. We understand that circumstances beyond your control may result in unanticipated cancellations. However, the camp is planned months in advance and many expenses are not adjustable once confirmed; furthermore, it is not always possible to fill a late vacancy. If your attendance at camp is uncertain for any reason, you are advised to wait to register if you cannot assume the financial risk of cancellation. Payment Payment Method * By check Online using credit card/PayPal (payment plan available through Paypal) After submitting form, you will be directed to the payment page. Registration is not complete until payment is received. Website/URL Submit If you are human, leave this field blank.
