Mustang Summer Camp Waitlist Step 1 of 2 50% Student Name* First Last Grade Entering*PreK4Kindergarten1st2nd3rd4th5th6thTshirt Size*Choose OneXSSmallMediumLargeAdult SmallAdult MediumAdult LargeParent/Guardian Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Email Address* Emergency Contact Name* First Last To be used if parent/guardian cannot be reached. Emergency Contact Relationship to Student* Emergency Contact Cell Phone*PaymentsRegistration Fee: If a spot becomes available, I understand that my FACTS account will be drafted for $40 (before April 22) or $50 (after April 23).* I understand. Since you are on the waitlist, your account will not be charged at this time. If a spot becomes available, you will be charged the registration fee. Mustang Day Camp Release FormI give my consent for the following person(s) to pick up my student in my absence:* Comments Authorization to Consent to Medical TreatmentIn the event I cannot be contacted to give consent, I hereby authorize Central Arkansas Christian, Inc. and any employees and agent to provide emergency first aid treatment for my student.Authorization to Consent to Medical Treatment*Choose OneYes, I give consent.No, I do not give consent.Comments Authorization of Administration of MedicineI give my consent for my child to be administered the following non-prescription medication(s) by Central Arkansas Christian, Inc.Select the medicine for which you give consent.* Acetaminophen (Tylenol) Ibuprofen None of the Above Comments Other MedicationParents must supply other medicine that may be required for the student. Such medication should be brought to the school in the original container properly labeled with the name of the student, identification of the medication, the dosage and the time to be administered. A Medicine Release Form (on the "CAC Summer Camp" page under Academics) must be filled out for each medication.Other Medication*Choose OneI will be supplying additional medication for my student.I will not be supplying additional medication for my student.AllergiesDoes your student have any allergies?* Yes No Please list any allergies your student has.ShuttlesIf you are interested in a morning and/or afternoon shuttle option, select which option below. PV Shuttle High School Shuttle Δ
