DUCKS Quiz Bowl Camp Registration: School
Please print legibly or type

 

School

 

School Address

 

 

 

Contact Person

 

Phone Number

 

E-Mail

 

Fax Number

 

 

Names, ages and grades of all individuals attending

 

 

 

 

 

 

Number of persons attending: ______ X $225 
Buzzer Discount: (-5 per student) _____
                    
Total Due  $ ______
(please make checks payable to DUCKS Quiz Bowl)

Please mail registration to:

DUCKS Quiz Bowl

UB Box 5859
408 S. Locust St.
Greencastle, IN 46135

Questions can be directed to:

Amanda Hartman
E-mail: quizbowlcamp@yahoo.com

 

 

REGISTRATION AND FEE DUE BY June 30, 2004

 

**No refund will be applicable for withdrawal from DUCKS Camp without two weeks prior notification, except for extreme situations
 DUCKS Quiz Bowl Camp Registration: Individual

 

Name

 

Age and Grade

 

School

 

Student email

 

Phone Number

 

T Shirt Size (all adult sizes)

____ S        _____ M       _____ L      ______ XL

 

 

Guardian Name

 

Address

 

 

Daytime Phone

 

Evening Phone

 

 

Emergency Contact Name and relation to student

 

Phone number

 

 

Secondary Emergency contact and relation to student

 

Phone Number

 

Policies and Procedures for DePauw University and DUCK Camp

  1. This camp is alcohol and drug free.
  2. Camp participants may only use and enter authorized areas of the University.
  3. Conduct which causes, threatens, or endangers the mental health, physical health or safety of any person(s), or creates an apprehension of such harm is prohibited.
  4. Any type of weapon, firework or incendiary device or material is prohibited.
  5. Misuse or tampering with the fire alarm system, fire extinguishers or other safety or security equipment is prohibited.
  6. Camp participants must remain at on campus/at camp functions unless accompanied by a camp official.
  7. Camp participants must follow any University, local, state, or federal law, ordinance, or regulation.

I, ____________________________ (print student name), agree to adhere to the policies and procedures of DePauw University and the DUCKS Camp. I understand that any deviance from these will result in my immediate expulsion from the camp.

___________________________ student signature   _________ date ___________________________ guardian signature _________ date

DUCKS Quiz Bowl Camp: Health Form

 

Name

 

School

 

 

List all known allergies

 

Are there any conditions which may inhibit your child’s participation in any camp activities?    Yes / No (If yes, please explain: )

Is he/she currently taking any medications? (including birth control) Yes / No

If yes, please list:

 

Health Insurance and Doctor Information

Health Insurance Company

 

Insurance Policy number

 

Doctor Name

 

Doctor phone number

 

May camp officials distribute over the counter medication (such as aspirin, antihistamines, cortisone, etc.) to your child? Please circle one:                   Yes/ No

 

I, ___________________________, guardian of ________________________ (student’s name) release any official of DePauw University and of the DUCKS camp of any liability. I trust that they will do all they can to ensure the health and safety of my student. I also give my permission for my student to be given emergency, medical treatment if necessary.

_______________________________________guardian signature ______ date