Middle School Summer Program Registration
Entering 7th & 8th grade

Time: 9:30 am – 3:30 pm (Drop off as early as 9:00 am). Culminating event for friends and family on Friday, July 12th from 4 pm – 6 pm

Light snacks will be available, please bring a sack lunch and water bottle.

Cost: $250 - Pay here:

https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=AGQR826NYVD66&source=url

*Full and partial scholarships available, contact Suzie Staley at suzie@neutral-zone.org*
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Email *
Teen First Name *
Teen Last Name *
Teen Email
Teen Phone Number
Teen Address
Teen Date of Birth *
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DD
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Parent 1 First and Last Name *
Parent 2 First and Last Name
Parent Email *
Parent Phone Number *
Parent Address *
Grade Teen is Entering Fall 2019 *
School Teen will be Attending *
Emergency Contact Name (Not Parent) *
Emergency Contact Phone Number *
Any Known Allergies? (Food/Medication)
Medication List
Program teen would like to attend *
I give full permission for Neutral Zone to use any photographs, films and/or sound recordings in which my child appears for publicity purposes, now and any time in the future, in any media. *
I hereby grant permission to Neutral Zone staff to perform basic first aid on my child and secure or administer other such emergency medical treatment as staff deem necessary. I understand that in case my child becomes ill or injured, parents, then emergency contact persons will be called immediately for their decision on medical treatment. If the parents or emergency contact listed are not immediately reachable, or if in the opinion of Neutral Zone staff the situation requires emergency action, NZ staff will use their judgment as to what medical treatment is appropriate. *
A copy of your responses will be emailed to the address you provided.
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