Archaeology Field School Registration Form 2024

Archaeology Field School Registration Form

Field School Registration Form

Step 1 of 2

July 29 – August 1, 2024 6pm – 8pm: The Castle

Please return registration papers along with payment by Friday, July 12, 2024 by 4pm to The Castle.

Enrollment in the Archaeology Field School at The Castle is for high school ages and adults. The registration fee of $50.00 per individual covers the cost of all the materials for the camp. As part of the registration process, please fill out the Emergency Medical Authorization and Photo Release forms, which are included. Field School size is limited to 12 participants on a first-come-first-served basis, so early registration is encouraged.

Name:(Required)

First Last

Mailing Address:(Required)

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

Phone (Best to reach you):(Required)

Email Address:(Required)

Age:(Required)

Grade Entering (if applicable):

Name of School: (if applicable)

Please note:

Friday, August 2 is reserved as a back-up day in the event of rain. Please make checks payable to: The Castle, 418 Fourth St., Marietta, OH 45750 For more information call The Castle at (740) 373-4180

In the event of an emergency, The Castle contacts emergency services, and then the primary and secondary contacts listed on this form. This form will be provided to emergency service personnel.

Emergency Medical Authorization

Name(Required)

First Last

Primary Emergency Contact Name:(Required)

First Last

Home Phone

Cell Phone:(Required)

Work Phone:

Secondary Emergency Contact Name:(Required)

First Last

Home Phone:

Cell Phone:(Required)

Work Phone:

Medical History

Allergies (Food, Pollen, Etc):(Required)

Food Preferences (Vegetarian, Vegan, Etc.):

Medications Being Taken:(Required)

Tell us a little about you/your camper:

My camper/I use(s) a wheelchair, crutches, walker or another mobility aid

My camper/I might be sensory sensitive

My camper/I has (have) vision loss

My camper/I is (am) deaf or hard-of-hearing

My camper/I has (have) an intellectual disability

Please elaborate on any boxes marked:

Is there anything else you wish for us to know about you/your camper?

Part I: To Grant Consent

I hereby give consent for the following medical care providers and local hospital to be called.

Doctor:(Required)

First Last

Phone(Required)

Dentist:(Required)

First Last

Phone(Required)

Medical Specialist:

First Last

Phone

Local Hospital:

First Last

Phone

Can we administrator first aid?(Required)

Yes

In the event, reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by the above-named doctor, or in the event that the designated practitioner is not available, by another licensed physician or dentist, and (2) transfer to any hospital reasonably accessible.

Date:

Signature/ Parent or Guardian Signature:

Part II: Refusal to Consent

I do NOT give my consent for emergency medical treatment of me, or my camper. In the event of illness or injury requiring emergency treatment, I wish The Castle authorities to take the following action:

Date:

Signature/ Parent or Guardian Signature:

Permission to Use Photograph:

Signature(Required)

Printed Name:

First Last

Printed Parent/Guardian Name:

First Last

Date:

Phone:

Registration Fees:

Registration fee per individual

Price:

Credit Card

Cardholder Name

Card Details