Tomahawk Overnight Registration | Sauganash Study Center

Personal Information

Name*

First Last

Father's Name*

Mother's Name*

Address*

Street Address City State ZIP Code

Home Phone Number*

Phone Number of Parent (emergency use only)*

Date of Birth*

Parent Email Address*

Miscellaneous

Medical Insurance Company*

Medical Insurance Group Number*

Medical Insurance Policy Number*

Medical Insurance Phone Number*

Electronic Signature for Medical & Photo Release*

As the parent or legal guardian of the participant identified on this registration, I hereby delegate authority to the Directors of the "Tomahawk Overnight" to arrange whatever medical treatment they deem necessary for him during the activity. Also, I hereby authorize and consent to the use and reproduction by Sauganash staff or an authorized agent or assignee of any and all photographs taken of my son for the purpose of promoting Sauganash programs, without any compensation to me. All film, together with any prints, shall constitute property of Sauganash, solely and completely.

Participant Signature*

I understand that there is an expectation of no complaining on The Tomahawk Overnight, and, as a grown man, I am prepared to live up to this expectation.

Comments

Please include any medical or dietary needs.

Tomahawk Adventure Overnight Registration

Personal Information

Miscellaneous