registration

Transaction ID#:

This is the 10 digit Transaction ID number emailed to you from Authorize.net

Date of Payment:

Campers Last Name:

Campers First Name:

Current Age:

Birthdate:

Sex:

Shirt Size:

Parent or Guardian:

Mailing Address:

City:

State/Country:

Zip/Postal Code:

Primary Phone:

Alternate Phone:

Parents or Guardian Email Address:

Session Camper will attend

Day Camper Session 1 Day Camper Session 2 Day Camper Session 1 & 2 Overnight Camper Session 1 Overnight Camper Session 2 Overnight Camper Session 1 & 2

Roommate Request:

Family Physician:

Physician Phone:

Date Last Tetanus Shot:

Medical / Accident Insurance Company:

Policy Holder:

Policy Number:

Known Alergies:

Employer:

I agree

By submission of this form, I hereby certify that my child is in good health and may participate in all camp activities. I will not hold the University or MJFS Camp responsible in the event of an accident or injury as a result of his or her participation. I also give permission for my child to be administered emergency medical treatment at a local hospital if needed. Additionally, I acknowledge and accept the terms of the Michael Jordan Flight School Cancellation Policy as stated on the MJFS website. All photos associated with camp may be used in future advertisements and promotions for MJFS.