Registration Information

Camp 1: June 8-12, 2015

Camp 2: July 6-10, 2015

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

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

Number of Children
One week: children

Both weeks: children

 
I am a member of ASTC and am registering 1 child ($25/child off regular price)
I am a member of ASTC and am registering 2 or more children (15% off member price)
I am NOT a member of ASTC and am registering 2 or more children (15% off regular price)
None of the above


 
Total*
$
 
If you have selected a 1-week session, please indicate which session the child(ren) will attend:
Child 1 Information
Name*
Child's Age as of June 7, 2015*
School*
Grade Entering Fall 2015*
Male/Female*
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*
Emergency Contact Telephone*
Child 2 Information
Name
Child's Age as of June 7, 2015
School
Grade Entering Fall 2015
Male/Female
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
Emergency Contact Telephone
Child 3 Information
Name
Child's Age as of June 7, 2015
School
Grade Entering Fall 2015
Male/Female
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
Emergency Contact Telephone
Child 4 Information
Name
Child's Age as of June 7, 2015
School
Grade Entering Fall 2015
Male/Female
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
Emergency Contact Telephone
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
Card Type*
Card Number*
Expiration Month*
Expiration Year*
Card Security Code*

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.

NOTE FOR PARENTS

Asia Society may plan local field trips as part of the 2015 Explore Asia camps. If you have any questions or would like more information, please contact Paul Pass at 713.496.9915.

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.

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