Weekdays, 9AM – 3PM 2021 Middle School Spring Break Camp - Session II: April 12 - 16 Registrant Name* First Last Relation of Registrant to Attendee(s)*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I would like to register:One AttendeeTwo AttendeesThree AttendeesA discount of 10% is automatically applied to the cost of registering multiple children in the same household.Attendee InformationAttendee Name* First Last Gender* Female Male Other Birth Date* Date Format: MM slash DD slash YYYY Grade*School Name*Attendee 2Attendee 2 Name First Last Email 2 Address 2 Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Gender 2 Female Male Other Grade 2Birth Date 2 Date Format: MM slash DD slash YYYY School Name 2Attendee 3Attendee 3 Name First Last Email 3 Address 3 Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Gender 3 Female Male Other Grade 3Birth Date 3 Date Format: MM slash DD slash YYYY School Name 3Parent/Guardian InformationParent/Guardian 1 Name First Last Parent/Guardian 1 RelationshipParent/Guardian 1 PhoneParent/Guardian 2 Name First Last Parent/Guardian 2 RelationshipParent/Guardian 2 PhoneAccommodations and AllergiesPlease explain any special accommodations that your child may need:Does your child have any allergies?*YesNoPlease explain:Does your child have any medical or behavioral needs which will require special attention from our staff?*YesNoPlease explain:Does your child take any medications?*YesNoDo you understand that your child's participation in this MEarth program will require full compliance with Covid-19 related safety measures, protocols, and communications, and that lack of compliance may result in the termination of their participation without refund of registration fees?*YesNoPlease explain:WaiverWaiver Statement:*I understand that checking the Terms & Conditions box below, and clicking the "Continue" button acknowledges that I have read, understand, and agree to the terms and conditions outlined herein as a condition of my child's participation in the MEarth program for which I am registering them. I further understand that checking the Terms & Conditions box below and clicking the registration “Continue” button has the same force of law as my original signature. I understand that I am not obligated in any way to make such agreement, except as a prerequisite to my child's participation in this program. By checking the box below and clicking the "Continue" button, I agree that all information submitted in this form is true and accurate to the best of my knowledge.I agreePaymentTotal $0.00 CAPTCHA