TUG Creative Writing Camp

Registration

Registration Type*

General Registration ($150) Child of a Cornerstone Employee ($125)

Quantity*

Student's Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Age*

Gender*

Female Male

Cell Phone Number*

Email Address*

High School*

Anticipated High School Graduation Year*

T-Shirt Size*

Food Sensitivities

Student Signature*

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Parent or Guardian Information

Name*

First Name

Last Name

Relationship to Student*

Cell Phone Number*

Email*

By submitting this form, I understand that my (my child's) participation may be photographed for use in promotional materials for Cornerstone University. I understand that photos may be used for publicity purposes.*

I have read and agree to the photo release statement above.

If you have any questions, please contact admissions@cornerstone.edu.

While participating in activities at Cornerstone University, both on and off campus, each student is assumed to be voluntarily performing activities for which he/she assumes all risk, consequences, and potential liability. I hereby release, waive, and hold harmless Cornerstone University, their employees, and enrolled students from and against all claims, demands, and causes of action of any type whatsoever, including property damage, personal injury, or death, arising out of or in any way related to my (my child's) involvement in activities on and off campus. I am aware that there are risks and dangers associated with my (my child's) participation and assume full responsibility for medical costs, any injuries, or damages I (my child) sustain as a result of my (my child's) participation, including the traveling. I give permission for Cornerstone's student volunteers and/or staff to drive me (my child) in a vehicle if the activities include going off-campus. I understand that all activities presented to me (my child), whether on campus or off, during the day are optional and if I participate it is by my own (my child's own) choice. *

I certify that I have read the foregoing and that the information set forth above is true and correct. I understand that if an accident occurs, my insurance coverage shall bear primary responsibility for any losses or claims for damages.

If you have any questions, please contact admissions@cornerstone.edu.

Parent or Legal Guardian Signature (required for students under 18)*

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Billing Address & Payment

Please enter your billing information as it appears on your credit card. Visa, Discover, American Express and MasterCard are accepted. All online payments include a non-refundable credit card processing fee (2.5%).

Name*

First Name

Last Name

Billing Email Address*

Billing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Credit Card*

Total Cost* $

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