Please complete the form below and click on "Submit" to register.


To submit this form, all "*" fields must be filled in.

Week One - Video Game Maker with Writers in the Schools (WITS) Digital (June 4-8):
children
 
Week Two - Manga Pop! (June 18-22):
children
 
Week Three - Storytelling Traditions Camp (June 25-29):
children
 
Week Four - Superheroes of Asia (July 9-13):
children
 
Week Five - Shadow Puppetry Camp (July 23-27):
children
 
Week Six - Amazing Asian Eats (August 6-10):
children
 
I am a member of ASTC
I am NOT a member of ASTC


 
Total*
$
 
Child 1 Information
Name*
Child's Age as of June 4, 2018*
School*
Grade Entering Fall 2018*
Child 1 Gender*
T-Shirt Size*
Address*
Please list any of your child's health issues of which we should be aware (i.e., allergies, limitations, etc.)*
Physician Name*
Physician Telephone*
Emergency Contact Name*
Camper allergies (food, environmental, medical)
What reaction do they have to their allergy?
If the camper has food allergies, what are their dietary needs?
Do they have an EpiPen?
What medication needs to be administered?
Other medical or accessibility needs (asthma, ADD/ADHD, behavioral, physical):
Emergency Contact Telephone*
Child 2 Information
Name
Child's Age as of June 4, 2018
School
Grade Entering Fall 2018
Child 2 Gender*
T-Shirt Size
Address
Click here to use the Address, Emergency Contact, and Physician information from Child 1
Please list any of your child's health issues of which we should be aware (i.e., allergies, limitations, etc.)
Physician Name
Physician Telephone
Emergency Contact Name
Camper allergies (food, environmental, medical)
What reaction do they have to their allergy?
If the camper has food allergies, what are their dietary needs?
Do they have an EpiPen?
What medication needs to be administered?
Other medical or accessibility needs (asthma, ADD/ADHD, behavioral, physical):
Emergency Contact Telephone
Child 3 Information
Name
Child's Age as of June 4, 2018
School
Grade Entering Fall 2018
Child 3 Gender*
T-Shirt Size
Address
Click here to use the Address, Emergency Contact, and Physician information from Child 1
Please list any of your child's health issues of which we should be aware (i.e., allergies, limitations, etc.)
Physician Name
Physician Telephone
Emergency Contact Name
Camper allergies (food, environmental, medical)
What reaction do they have to their allergy?
If the camper has food allergies, what are their dietary needs?
Do they have an EpiPen?
What medication needs to be administered?
Other medical or accessibility needs (asthma, ADD/ADHD, behavioral, physical):
Emergency Contact Telephone
Child 4 Information
Name
Child's Age as of June 4, 2018
School
Grade Entering Fall 2018
Child 4 Gender*
T-Shirt Size
Address
Click here to use the Address, Emergency Contact, and Physician information from Child 1
Please list any of your child's health issues of which we should be aware (i.e., allergies, limitations, etc.)
Physician Name
Physician Telephone
Emergency Contact Name
Camper allergies (food, environmental, medical)
What reaction do they have to their allergy?
If the camper has food allergies, what are their dietary needs?
Do they have an EpiPen?
What medication needs to be administered?
Other medical or accessibility needs (asthma, ADD/ADHD, behavioral, physical):
Emergency Contact Telephone
Medical/Allergies
Parent or Guardian Information
Salutation
First Name*
Last Name*
Relationship to Child/Children*
Address*
City*
State*
Zip*
Phone*
What is the best time to contact you?*
Email*
Confirm Email*
Please add me to the ASTC email list:
Please add me to the ASTC mailing list:
How did you hear about the Explore Asia Summer Camp:*
Payment Details
Payment Info

LIABILITY WAIVER

By clicking "Submit," I hereby certify that I am the parent or guardian of the child/children listed above and give my consent to this liability waiver. I agree, on behalf of myself and my child/children, to the following: I grant my permission for my child/children to participate in activities associated with the Explore Asia Summer Camp. I am fully aware of the risks and hazards connected with my child/children’s participation in these activities, and hereby elect to allow my child/children to voluntarily participate, knowing that the activities may be hazardous to my child/children or to his or her property. On behalf of myself and my child/children, I voluntarily assume all responsibility for any risks, loss, property damage, or personal injury, that may be sustained by my child/children or myself. I hereby pledge not to sue Asia Society Texas Center, including its agents, employees, and representatives and to release, waive, and discharge said agents, employees, and representatives from any and all liability, claims, demands, actions, and causes of action arising out of loss, property damage, or personal injury that may occur during the Explore Asia Summer Camp activities.

PHOTOGRAPHY RELEASE

By clicking "Submit," I grant permission to Asia Society Texas Center, including its agents, employees, and representatives (“ASTC”), to use any and all photographs taken of me and/or my child/children on the date during the Explore Asia Summer Camp. The photographs may be used in any and all ASTC publications, including but not limited to newsletters, brochures, promotional materials, website illustrations, fundraising efforts, and advertising, without payment or other consideration. I authorize ASTC to edit or alter the Photographs as may be necessary for publication, without further notice to me. I hereby hold harmless and release ASTC from all claims, damages or liability which I, my child, or any other person may have by reason of the ASTC use of the Photographs.

PRIVACY STATEMENT

All personal data collected through this application will be utilized for the Asia Society Texas Center Explore Asia Summer Camp and Educational Programs purposes only.