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Rowan University

Career Explorer Camp 2014 at Rowan University Career Management Center Form

Child's Information:
Name of Child:
Grade as of 9/14:
DOB:
Gender:



Male Female
Child's Information:
Name of Child:
Grade as of 9/14:
DOB:
Gender:



Male Female
Parent/Guardian Information:
Name:
Address:
Home Phone:
Place of Employment:
Work Phone:
Cell Phone:






Parent/Guardian Information:
Name:
Address:
Home Phone:
Place of Employment:
Work Phone:
Cell Phone:






Emergency Contact:
Name:
Telephone #:
Cell #:



Emergency Contact:
Name:
Telephone #:
Cell #:



Emergency Contact:
Name:
Telephone #:
Cell #:



Emergency Contact:
Name:
Telephone #:
Cell #:



Other Information:

Agreement: Please note that all of your listed emergency contacts have the permission to pick-up your child(ren).

I give permission for photographs, write-ups of camp activities to be used in any of our newsletters/publications and website

if you have a court order that would prevent anyone from picking up your child (ren) from camp. You must submit a copy of your court order to the Career Management Office. Please list any persons and relationship to child (ren) NOT able to pick up your child (ren).