NFB CAMP REGISTRATION FORM

NFB CAMP REGISTRATION FORM

Future Reflections Special Issue on Low Vision NFB CONVENTION 2014
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NATIONAL FEDERATION OF THE BLIND ANNUAL CONVENTION
July 1 through July 6, 2014
NFB CAMP REGISTRATION FORM
Completed form and fees must be received on or before June 15.
Parent’s/Guardian’s Name ________________________________________________
Address ________________________________________________________________
City _______________________________ State _________________ Zip __________
Home phone _________________________ Cell phone ________________________
Cell phone___________________
NFB Camp may text your cell phone? __Yes / ___ No
Child(ren)’s Name(s)
_______________________________ Age ____ Date of Birth ____________________
_______________________________ Age ____ Date of Birth ____________________
_______________________________ Age ____ Date of Birth ____________________
Include description of any disabilities or allergies we should know about:
_______________________________________________________________________
_______________________________________________________________________
Who, other than Parent/Guardian named above, is allowed to pick up your child(ren)? _________________________________________________
Per Week: (Does not include banquet.)
___ Total #child(ren). $100 for first child + $75 x _____ #Siblings = $ __________
(or) Per Day: (Does not include banquet.) Circle: TUES. THURS. FRI. SAT. SUN.
$25 per child per day. $25/child x _____ # of children x ______# of days = $ ________
BANQUET (box lunch): ____# Turkey Sandwiches. ____ #Cheese Sandwiches.
$25 per child x _____ # of children = $__________
TOTAL: $ _________
We understand that NFB Camp is being provided as a service to make our convention more enjoyable for both parents and children. We will pick up children immediately following sessions. We understand that, if our child(ren) does not follow the rules or if for any reason staff are unable to care for our child(ren), further access to childcare will be denied.
Parent’s/Guardian’s Signature: _______________________________ Date:_________

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