BHHA Camp Registration

Hands on History Day Camp Registration

Hosted by the Bradford House Historical Association
To register, please complete and submit this form, including payment of $100 camp fee. Enrollment will be limited to the first 12 participants who complete this registration form and payment.
Youth Participant *

First Name Last Name
Child's Age *
Grade completed in 2020

3rd 4th 5th
Allergies, Dietary Restrictions or Special Conditions
Emergency Contact Number (day of event) *

Area Code Phone Number
Emergency Contact Name *

First Name Last Name
Emergency Contact Relation to Child *
Parent or Guardian's Name *

First Name Last Name
Parent or Guardian's Email *
example@example.com
Parent or Guardian's Phone (during event) if not Emergency contact *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State

Zip
Expectations during event:

Parents/guardians are responsible for transportation. If transportation will be from someone other than parent or guardian, then the staff of the event must be notified as children must be signed into and out of event daily. Please provide the name(s) of those to whom the child may be released. Children will not be released to third parties without confirmation from guardians.

Children should not be dropped off before 8:50 a.m. and must be picked up by 12:10 p.m.
Disclaimers:

I/We refer to Parent or Guardian of Child.

I/We do hereby permit my/our child to participate in various activities offered by the Bradford House Historical Association during the Hands on History Day Camp to be held Monday, August 3 through Friday, August 7, 2020 from 9:00 a.m. until 12:00 noon at the Bradford House Museum, 175 South Main Street, Washington, PA 15301.

I/We do hereby release the Bradford House Historical Association and Staff from any liability due to accident or injury incurred during the day camp's activities.

I am, under perjury of law, the guardian listed on this document and consent to these waivers.

All event staff will be screened with appropriate background check and clearances in accordance with Pennsylvania law.
Agreement to Disclaimer *

I/We agree with and understand the above Disclaimers and expectations of us.
Paypal Payment

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USD $100 payment for day camp.
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Hands on History Day Camp Registration