Participant Information:
Name: __________________________________________________________________________________
Date of Birth: ____________________________________________ Age: ____________________
High School: ______________________________________________________________________
Mailing Address: __________________________________________________________________________
City, State: ________________________________________ Zip Code: _____________________
Parent Permission:
Applicable to campers under 18 years old (i.e. DOB on and after May 31, 1998) attending Wayland Baptist University #CampWRITE
without parent/guardian.
I, ___________________________________________, consent to my child participating in the
academic camp organized by Wayland Baptist University School of Languages and Literature on
June 16 – 18, 2016.
I agree that my child’s participation in the academic camp is purely voluntary. I agree not to hold
Wayland Baptist University liable or responsible for any loss or injury sustained by my child arising in
connection with participation in the camp activities.
I can be contacted at _____________________________ (telephone number) in the event of an
emergency.
Other Information (for example, food allergies, special accommodations, etc.):
________________________________________________________________________________
_________________________________________________________________________________________________
Signature of Parent/Guardian: _______________________________________________________
Name of Parent/Guardian: __________________________________________________________
Date: __________________________________