Camp Sign Me Up 2023

My child will attend the following weeks:*
Please note, BridgesTN will be closed in recognition of Juneteenth, so there will be no CSMU that day.
What time will camper be dropped off:*

8:30 a.m. (for beforecare)9:00 a.m.
What time will camper be picked up:*

3:00 p.m.4:00 p.m. (for aftercare)
Student's Name*

First NameLast Name
Gender*
Age*
Date of Birth*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School
T-Shirt Size*
Hearing Status
Has your child attended CSMU in the past? If yes, when?
Please describe any past experience with ASL your child has had. Let us know if this is their camp will be your child's introduction to the language.
Parent or Guardian's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Day Phone

Area CodePhone Number
Night Phone

Area CodePhone Number
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Email*
example@example.com
How did you learn about us?
Emergency Contact*

First NameLast Name
Day Phone

Area CodePhone Number
Night Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Alternate Emergency Contact

First NameLast Name
Relationship to camper:
Day Phone

Area CodePhone Number
Night Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number

Medical Information
Known medical conditions that might affect student's participation in CSMU*
asthma, allergies, etc.
Is camper on medication?*
Is camper ALLERGIC to any medication?*
If yes, what medication:
medication camper is on
If yes, what medication:
medication camper is allergic to
Is participant currently under the care of a doctor? If so, please include doctor's name & phone number.

Releases & Consents
Media Release

I give my permission for Bridges to allow photographs or interview statements of my child to be used as part of any publicity coverage that may occur including newsletters, public relations materials, or coverage by area media in regard to Bridges’s youth center programming.
*

yesno
Please Sign & Date*

Clear
Activity Consent

During Camp Sign Me Up, the camper will have the opportunity to participate in various activities including: arts and crafts, sports and games, educational seminars, and outdoor activities. As a parent/guardian, I understand the nature of these activities and give permission for my child to participate.
Please Sign & Date*

Clear
COVID-19 Protocols

My family agrees to abide by all COVID-19 and other safety guidelines and protocols. We understand that BridgesTN may update those guidelines and protocols as needed.
Please Sign & Date*

Clear

We ask that you complete a form for each child, but please list the name(s) of other campers here for reference:
My Products*
prevnext( X )
In-Person Camp for 1 child$125.00

Number of Weeks

In-Person Camp for additional child | must live in same household$120.00

Number of Weeks

Before and After Care Option$40.00

Quantity

Total $0.00
Should be Empty:

Medical Information