michigan's adventure REGISTRATION

The cost of this trip is $35 per student. it includes transportation, lunch and ticket to michigan's adventure. Please turn in your money to Rachael Decker or Becca West no later than August 6.

Student Name *
Student Name
Date of Birth *
Date of Birth
Grade entering in Fall 2017
Student Phone
Student Phone
Address *
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Phone *
Parent/Guardian Phone
Emergency Contact Name
Emergency Contact Name
(if different from parent/guardian)
Emergency Contact Phone
Emergency Contact Phone
(i.e. allergies, medications, medical conditions)
Liability Waiver *
Behavioral Policy *
Media Release *
Parent/Legal Guardian Signature *
Parent/Legal Guardian Signature
"By typing my name, I agree that I am the above age-18 legal guardian for this student and agree that I have read the above waiver/release form."