pole-vault-camp - Central Arkansas Christian Schools

Pole Vault Camp

Step 1 of 2 – Register for soccer camp

Today's Date*
MM slash DD slash YYYY
Pole Vault Camp
Contact Coach Daniel Bristo (dbristo@cacmustangs.org) with questions.
Student Name*
First Last
Student Birthdate*
MM slash DD slash YYYY
Grade Entering*
Tshirt Size*
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Email Address*
Emergency Contact Name*
First Last
Emergency Contact Relationship to Student*
Emergency Contact Cell Phone*

Mustang Athletics Summer Camp Release Form

I give my consent for the following person(s) to pick up my student in my absence:*

My student has the following allergies:
Comments
Authorization to Consent to Medical Treatment
In 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*
Comments
Authorization of Administration of Medicine
I 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 Medication
Parents 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 (found on the Summer Camp Homepage) must be filled out for each medication.
Other Medication*
Mustang Athletics Summer Camps Release
I understand and agree that my electronic signature releases the camp, CAC and any participating party from liability in the event of injury and/or treatment of an injury, illness, or medical problem. My electronic signature also authorizes the treatment of an injury or medical problem by trained medical personnel in the event of an emergency. I also understand that the camp/CAC will not carry insurance for any camper and that any costs incurred in the treatment of any injury or medical problem are the camper’s responsibility.
Mustang Athletics Summer Camps Release*
- I understand the terms and agree. This is my electronic signature.
Payment
$115 per child
Payment*
- CAC STUDENTS: Draft my FACTS account.
- NON CAC STUDENTS: Cash/Check
All checks & cash should be mailed to Lynn Brown at the North Little Rock Elementary campus. (ATTN: Lynn Brown | 6101 John F Kennedy Blvd, North Little Rock, AR 72116. You may also drop off your payment at the Secondary Campus front office in an envelope labeled with your student’s name and “Mustang Athletic Camp Payment.” All checks should be made out to CAC with the camp specified on the subject line.
Please check this box if you are registering a sibling of a student who has already been registered for this camp.
- Registering a sibling.

Quick Links:

Pole Vault Camp

Step 1 of 2 – Register for soccer camp

Pole Vault Camp

Mustang Athletics Summer Camp Release Form

Authorization to Consent to Medical Treatment

Authorization of Administration of Medicine

Other Medication

Mustang Athletics Summer Camps Release

Payment