Camper Registration

Camper Name *
Camper Name
Camper Birthdate *
Camper Birthdate
Grade Entering Fall 2015 *
Parent Name *
Parent Name
Address *
Address
Cell Phone
Cell Phone
Other Phone
Other Phone
Camp Selection: *
Camp Times: 9am to 3pm Monday through Friday Camp Location: 123 R Dayton St Danvers MA 01923
Release: *
I grant to Girls Making History/GMH, its representatives and employees the right to take photographs of my child in connection with GMH related activities. I authorize GMH, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that GMH may use such photographs of me without name, and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.
Payment: *
Camp registration fee is due and payable on or before camp start date. Checks are written to: Dallas Bradel, and mailed to PO Box 2182, South Hamilton, MA 01982