Honey Shine | Honey Shine Program Registration

HONEY SHINE PROGRAM REGISTRATION

HONEY SHINE PROGRAMS*

CHILD NAME*

First Last Suffix

CHILD DATE OF BIRTH*

CHILD CURRENT GRADE*

ETHNICITY*

Black or African American
White
Hispanic, Latino or Spanish
Asian
American Indian or Alaskan Native
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander

TSHIRT SIZE

CONTACT INFORMATION

PARENT/GUARDIAN FULL NAME

First Last

HOME ADDRESS*

Street Address Address Line 2 City State ZIP Code

EMAIL*

CELL PHONE

WORK PHONE

HOME PHONE

SECOND PARENT/GUARDIAN FULL NAME

First Last

SECOND PARENT/GUARDIAN HOME ADDRESS

Street Address Address Line 2 City State ZIP Code

SECOND PARENT/GUARDIAN EMAIL ADDRESS

SECOND PARENT/GUARDIAN PHONE

EMERGENCY CONTACT / MEDICAL REFERENCE

EMERGENCY CONTACT FULL NAME (1)

First Last

EMERGENCY CONTACT PHONE (1)*

EMERGENCY CONTACT RELATIONSHIP (1)*

EMERGENCY CONTACT FULL NAME (2)

First Last

EMERGENCY CONTACT PHONE (2)*

EMERGENCY CONTACT RELATIONSHIP (2)*

EMERGENCY CONTACT FULL NAME (3)

First Last

EMERGENCY CONTACT PHONE (3)*

EMERGENCY CONTACT RELATIONSHIP (3)*

LIST STUDENT ALLERGIES IF APPLICABLE

RELEASE & WAIVERS

PUBLICITY RELEASE*

YES - I DO WANT my child to be photographed or interviewed by the news media.
NO - I DO NOT WANT my child to be photographed or interviewed by the news media.

Many parents enjoy seeing their children’s pictures in the newspaper and on television; however, some parents do not want their children identified for various reasons. If you do not want your child photographed, Honey Shine, Inc. will make an extra effort to see that your child is not available to the news media. Realistically, all situations cannot be controlled, and Honey Shine, Inc. cannot guarantee that a child will not be identified in the news media reports, etc.

RELEASE & WAIVER*

AGREE

By checking the AGREE BOX this legal document, you are giving up any legal rights you may have to sue Honey Shine, Inc., Mourning Family Foundation, and Carrollton School of the Sacred Heart and all other Mourning Family Foundation organizers and sponsors in court for money damages. READ FULL DOCUMENT HERE

ZERO TOLERANCE POLICY:*

AGREE

By checking the AGREE BOX this legal document. Honey Shine endorses a zero tolerance policy toward camper and/or parent behavior that disrupts or infringes upon the rights of other individuals including staff. Zero tolerance at Honey Shine means “First Occurrence” of unacceptable behavior or conduct will result in automatic dismissal from the program. READ FULL DOCUMENT HERE

BILLING INFORMATION

GRAND TOTAL

$0.00

CREDIT CARD INFORMATION

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

NAME*

First Last

BILLING ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

EMAIL*

PHONE*

CAPTCHA

Honey Shine Program Registration

Honey Shine Internal Registation

HONEY SHINE PROGRAM REGISTRATION

CONTACT INFORMATION

EMERGENCY CONTACT / MEDICAL REFERENCE

RELEASE & WAIVERS

BILLING INFORMATION