Student's Name, Age, & Birthdate * Parent/Guardian Name(s) * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (Best number to reach you.) * (###) ### #### Email * Would you like to join our eNews list? Yes No Allergies/Other Health Conditions * Alternate Emergency Contact/Relationship/Phone Number * List Others Who May Pick Up Your Child Do we have your permission to photograph your child? * Your permission allows the registered student to be photographed for publicity purposes, including but not limited to media coverage during his/her visit to HMA, and releases HMA from liability and demands for compensation, award or other considerations whatsoever arising from the enrolled appearing in such material. Yes No I would like to register my child for the following camp(s)/workshop(s): * Please specify the date and time for your desired camp as a few of our camp themes are repeated on different weeks. Payment Preferences Yes, please invoice me so that I can pay online. I would prefer to arrange to pay in a different way. Are you a HMA Member? Yes No If not, would you like to join? Yes No Would you like for your child to stay for lunch? Supervised lunch and recreation will be available from 12-1 PM for an additional $25 per week. Campers should bring a brown-bag lunch to enjoy as a group. Early Drop-Off is available through Catawba Science Center (CSC). Please call CSC at (828) 322-8169 for more information. Yes No My child needs to be picked-up at 10 AM from CSC’s Early Drop-Off. Yes No My child needs to be escorted to CSC’s Afternoon Camp at Noon. Yes No My child needs to be picked up from CSC after AM camp sessions . Yes No Thank you! You will soon receive an invoice email from Karla Starnes to process payment. Please note that the invoice emails are processed Monday-Friday during normal business hours. If you have any questions, please contact Karla at 828-327-8576, ext 207.
