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* 1. Student Contact Information:

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* 2. What school does your student currently attend?

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* 3. May this student be photographed or videoed during camp for reporting and advertising purposes?

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* 4. Has this student ever participated in BizTown?

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* 5. PICK-UP PROCEDURES
JA follows a strict pick-up policy. Be sure to include all individuals to whom your child may be released at pick-up time. Your child will not be released to
any person whose name does not appear on this list. NO EXCEPTIONS to this policy will be granted.

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* 6. Emergency Contacts
Please note which individuals you wish JA to contact in the event of an emergency and parent/guardian cannot be reached.

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* 7. MEDICAL RELEASE
Parent or guardian signature is required for registration.
I do hereby grant permission to Junior Achievement of East Tennessee and their respective agents and employees to secure
such medical aid and hospital services as may be deemed necessary for the child noted on this form in the event he/she
should sustain injury or illness while attending a summer program. I agree to assume the cost for transport and medical
treatment in such an emergency situation.
I have indicated below any medical information of which Junior Achievement of East Tennessee should be aware in consideration of the child’s
physical and mental well being.
I hereby release and discharge Junior Achievement of East Tennessee from any and all financial responsibility for medical care and/or
transportation of such child to receive medical care. I agree to indemnify and hold harmless Junior Achievement of East Tennessee from any and
all claims, damages, costs, attorney’s fees or damages of any kind arising out of participation in camp.

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* 8. Parent or Guardian must enter their name below and click the box to sign electronically to complete registration.

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* 9. Click to sign.

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* 10. You can complete your registration today by following the link to pay now!  The cost for this experience is $50.  ******Please return to this page to complete registration.****** Pay Now

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