Services and Programs /
Summer Courses /
Summer Camp Registration
First NameLast NameMiddle InitialBirth Date
[None] Student’s grade next fall: T-shirt size:
Home Mailing Address Street Address
City State Zip CodeHome phone
Parent’s/Legal Guardian’s First NameLast Name Parent’s/Legal Guardian’s email address (We will use this email to share information about the camp.) Daytime PhoneHome PhoneCell Phone
NamePhoneRelationship to participantDo you wish to be put on a waiting list if the program is full?
How did you hear about our camps?
From a website
Friend or family member
Teacher or guidance counselor
I/We, the undersigned, individually and as parent(s) or legal guardian(s) of , , a minor, ask that he/she be admitted to participate in this camp sponsored by Capital University. In consideration of such admission, I/we do hereby agree to release, discharge, and hold harmless Capital University, its officers, agents, and employees of and from all causes, liabilities, damages, claims, or demands whatsoever on account of any injury or accident involving the said minor arising out of the minor’s attendance at the camp or residence in University housing, or in the course of activities held in connection with the camp. Signature (At least one is required to complete registration.) Parent’s/Legal Guardian’s signature Date
[None] Enroll the camper in:
Registration Fee (Please ask about 5% discount for sibling groups, returning campers, or relatives of Capital staff/faculty/students/alums.)
QUESTIONS AND COMMENTS:
Attn: Dr. Sharon Croft Department of Communication, Huber-Spielman Hall Capital University Bexley, OH 43209 Fax: 614-236-6169 Phone: 614-236-6338 Email: firstname.lastname@example.org By clicking "Submit Form," you are consenting to the terms and conditions on this form. After clicking "submit" you will be led to our secure payment server to complete registration payment.