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Your First and Last Name
Your Email Address
Child's Date of Birth
Grade Completed (as of June 30, 2019)
Child 6-8 (S)
Child 10-12 (M)
Child 14-16 (L)
District of Columbia
Zip / Post Code
Parent/Guardian Contact Information (Please include any names, addresses, email addresses, and phone numbers.)
Emergency Contact Information for Alternate Pickup/Release (Include any names and phone numbers of additional people who are permitted to pick up your child. Please note their relationship to your child.)
Child's Primary Physician and Phone Number
Are there any medications or other medical conditions that we should be aware of or that a medical personnel would need to know about if an emergency occurred and you could not be reached?
Does your child have any allergies?
Does your child require a special diet?
How did you hear about Pioneer the World Day Camp?
While the Swedish American Museum will take all reasonable steps to provide individual care and safety for your child, the Museum will not assume responsibility for any injury, damage, or harm that might result during the course of any activity during the program. In permitting your child to participate, you expressly agree that all such responsibility will remain with and is assumed by you, as the parent or guardian of the child, and release the Swedish American Museum, its trustees, officers, employees and agents from any and all liability. If a medical emergency arises, every effort will be made to contact you or the person designated on your registration form. However, if you cannot be contacted immediately, you agree to authorize the Swedish American Museum or its employees or agents to request and authorize, at your expense, emergency medical treatment. By submitting this form, you agree that you have read this liability waiver and grant permission for your child to participate fully in this program.
By checking this box, you agree that you have read this optional photo release, and that you hereby grant the Swedish American Museum, and their legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs of the minor listed on this form, or in which that minor might be included, for editorial, trade, advertising and any other purpose and in any manner and medium including electronic usages (websites, photo disks, email, online stock, etc); to alter the same without restriction; and to copyright the same. By checking this box, you hereby release the Swedish American Museum and its legal representatives and assigns from all claims and liability relating to said photographs.