Name Male Female Age Grade Address City State Zip School email cell phone home phone work phone Father's Name work phone Mother's Name phone Emergency Contact If so please explain: I have allergies By clicking "Submit" below, both the parent and the child agree to the following: I hereby grant my son/daughter permission to attend this event.  I am familiar with the program, its regulations and the code to which he/she will adhere.  I am aware that I will be held responsible for any damage to public or private property that my son/daughter causes and agree to reimburse all parties involved.  In case of medical emergency, I understand that every effort will be made to contact parents or guardian. In the event that I cannot be reached, I hereby give permission to the physician selected by NCSY to hospitalize, secure proper treatment for, and administer injections, anesthesia or perform surgery for my child as named above. Parent: In registering for this event, I will, to the best of my ability, adhere to the program, observe the religious code set by the UOJCA Joint Youth Commission, and conduct myself in a proper and dignified  manner. Child: Payment method: I will mail a check to NCSY 1131 University Blvd. W #1001 Silver Spring MD 20902 Pay by credit card - after you click "Submit", hit "Back" and click the PayPal button below. The registration WILL NOT be processed until we have your credit card payment or check!

white water rafting - june 14