418 4th Street • Marietta, Ohio 45750 • 740.373.4180
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Archaeology Field School Registration Form 2024
The Castle
>
Archaeology Field School Registration Form 2024
Archaeology Field School Registration Form
Field School Registration Form
Step
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2
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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
No
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:
MM slash DD slash YYYY
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:
MM slash DD slash YYYY
Signature/ Parent or Guardian Signature:
Permission to Use Photograph:
Consent
I agree that The Castle may use such photographs of my camper with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, web content, and social media.
Consent
I do NOT grant to The Castle, its representatives and employees the right to take photographs of me, or my camper in connection with the above-identified event.
Signature
(Required)
Printed Name:
First
Last
Printed Parent/Guardian Name:
First
Last
Date:
MM slash DD slash YYYY
Phone:
Registration Fees:
Registration fee per individual
Price:
Credit Card
Cardholder Name
Card Details
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Archaeology Field School Registration Form 2024
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