Aviation Camp registration form Test - Airbase Arizona Flying Museum

Student's first name*

Student's last name*

Parent/Guardian first and last name*

Email address of Parent/Guardian*

We must be able to communicate with the Parent/Guardian prior to and during camp.

Cell/mobile phone number of Parent/Guardian*

Student's gender*

Male
Female

Mark only one oval

Student's grade this current school year (2022-2023)*

7th Grade
8th Grade
9th Grade

Mark only one oval

Name of school student attends*

Name of student's school DISTRICT*

Birthdate*

Citizen Status - required for Boeing tour*

United States
Mexico
Canada

Mark only one oval

Behavior

Campers will be expected to follow directions, display appropriate/respectful behavior and get along well with all students/volunteers during all activities throughout Aviation Camp. Negative behavior may result in a student losing the privilege to attend field trips or attend camp entirely. (In this situation, refunds or partial refunds will NOT be available.) This will be addressed in more detail prior to camp. Part of the selection process includes a behavior/attitude referral from the student's teachers. Please make sure the contact information for the teachers is correct.

Parent/Guardian Name*

By typing your name (Parent/Guardian), you confirm that you have read and support this behavior criteria.

Your child's science teacher's first and last name*

We will be contacting teachers for referral purposes. Our inquiries will primarily focus on behavior, not necessarily grades.

Email address of your child's science teacher*

We will contact applicant's teachers prior to registration approval.

Phone number of your child's science teacher*

Another teacher's first and last name of a core class (Math, English, History) in which your child is currently enrolled*

Email address of the above named teacher*

Phone number of the above-named teacher*

Media Release Form

Often times multiple entities wish to interview students and/or take their photo for various district or community publications and/or internet websites. These entities may include, but are not limited to: Arizona Commemorative Air Force Museum (and national Commemorative Air Force); Boeing; The City of Mesa - Falcon Field Airport; Newspapers, television stations, internet news sites

Parent/Guardian Name*

By typing your name, you agree to sign a media waiver giving consent for your child to be involved in any of the above in relation to the Summer Aviation Camp program.

Medical Treatment Authorization/Hold Harmless

On completion of registration, you will be asked to sign a Medical Treatment Authorization form and Hold Harmless Agreement similar to the following: In the event of illness or injury occurring to my child while participating in Aviation Camp activities, I hereby give my consent for medical or dental care deemed necessary by the attending health care provider or dentist. My child may be examined and any necessary procedures (medical, dental, or surgical), anesthesia, or diagnostic procedures (lab or x-ray) may be performed under the supervision of a member of the hospital or medical office staff furnishing such services. I also acknowledge that I am financially responsible for any medical, dental, ambulance, or other health care expenses or transportation of my child home, which might occur as a result of such illness or injury. I understand that, in the event of other than minor illness or injury, reasonable effort will be made to contact me.

Parent/Guardian Name*

By typing your name, you agree to sign the medical treatment authorization and Hold Harmless agreement prior to Aviation Camp.

Is your child currently under a doctor's care?*

Yes
No

Please specify any health issues or allergies. Type "none" if not applicable.*

Is your child on any medication?*

Yes
No

If your child is on medication, please briefly explain and/or list medication and diagnosis/reason for giving. Type "none" if not applicable.*

Travel Permission

Parent/Guardian name*

By typing your name, you give consent for your child to attend all field trips for Aviation Camp, including, but not limited to, the following locations: Falcon Field Airport; Gateway Airport/Chandler-Gilbert Community College; Sky Harbor Airport; Boeing

Miscellaneous

How did you hear about Aviation Camp?

Phone

This field is for validation purposes and should be left unchanged.