Maritime & Seafood Industry Museum

Camp Week*

Camper's Name*

First Last

Camper's Age*

Please select the age your child will be at the time of camp, not the time of registration.

Gender*

Parent/Guardian 1*

We will use this as the emergency contact person.

First Last

Primary Phone*

Secondary Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 2

We will use this as the secondary emergency contact person.

First Last

Primary Phone

Secondary Phone

Email

T-Shirt Size*

Does your child take regular medications?*

Please specify.

Will your child need to bring this medication to camp?*

If yes, please bring in a seal-able bag with your child's name, dosage, & directions for our camp leaders.

Any known allergies?*

Please specify.*

Health Concerns

May your child be given Tylenol?*

Is your child required to wear a Life Jacket for the Sailfish Trip?*

Life jackets ARE NOT required on Sailfish per U.S. Coast Guard Regulations. This is an enclosed boat.

Sea N Sail Adventure Camp Agreement:*

This is to certify that as the parent/legal guardian of the above named camper; I give my child permission for his/her participation in the Sea-n-Sail Adventure Camp. I further certify that I release from any and every liability, claim, right of action of any kind or nature which my child’s legal representative may have for any and all bodily or personal injuries or property damages and any other damages resulting there from which might occur during participation in this facility which this program is conducted.

Required Parental Authorizations

The following people, including parent/guardian, may pick up and drop off my child (A photo identification will be required)*

Any person not listed will not be allowed to check out your child.

Photography Permission*

Do you give permission for your child, as named above, to be photographed or videotaped during Sea-n-Sail Adventure Camp? This includes photos that may be used for promotional or publicity purposes.

I give permission.
I DO NOT give permission.

Field Trip Permission*

My child, as named above, has permission to participate in any and all field trips that are a part of Sea-n-Sail Adventure Camp.

I agree.

Emergency Medical Treatment*

The Sea-n-Sail Adventure Camp has permission to obtain emergency medical treatment for my child, as named above.

I agree.

We have a zero tolerance policy to bullying.*

I understand.

Immunization Verification

This information is required for our files. Failure to supply this information will make your child ineligible for Sea-n-Sail Adventure Camp attendance, as required by the MS State Dept. of Health.

Verification*

I verify that my child, as named above, has received all age appropriate immunizations.

Doctor or Clinic:*

Doctor / Clinic Phone Number:*

Doctor/Clinic Address:*

Street Address Address Line 2 City State ZIP Code

Payment

Cost per week is $200.00. A non-refundable pre-registration fee of $50.00 is required with the application, (this is part of the original total). The fee balance is due the first camp day of the week the child is enrolled. The total fee is acceptable at the time of registration. The camp fee includes all costs of instruction, class materials, admission fees at historical sites, and transportation. Families with three (3) or more participants will receive a 20% discount, (this comes off of balance after deposit).

Price*

Deposit Only ($50)
Half now/Half later ($100)
Pay in full ($200)

Total

$0.00

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Email

This field is for validation purposes and should be left unchanged.

2019 Summer Camp

2019 Summer Camp

Required Parental Authorizations

Immunization Verification

Payment

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2019 Summer Camp

2019 Summer Camp

Required Parental Authorizations

Immunization Verification

Payment