Field Trips - Hagood Mill Historic Site

Camper Information

Camper's Name*

First

Last

Camper's Date of Birth(mm/dd/yy)*

Please list any allergies/conditions of camper:*

Parent/Guardian Information

Parent/Guardian Name:*

First

Last

Parent/Guardian Email*

Parent/Guardian Phone*

Area Code

-

Phone Number

Parent/Guardian Address*

Street Address City State / Province / Region Postal / Zip Code

Emergency Contact Information

Emergency Contact 1:*

First

Last

Emergency Contact Phone 2:(1)*

Area Code

-

Phone Number

Emergency Contact 2:*

First

Last

Emergency Contact Phone 2:*

Area Code

-

Phone Number

Focus Groups Selection

Permissions

Do you give permission for photographs or video to be taken and used to promote the Programming at the Hagood Mill Historic Site. This use includes social media, newspapers, brochures, and banners. I understand these promo items will be used for no other purpose.*

Yes

No

Do you wish to be added to the Hagood Mill mailing list?*

Yes

No

Camp Fee*

Camp Fee - $175

Please note that 4% is added to the total to cover the payment processing fees.

Total

Camp Hagood Registration

Camper Information

Parent/Guardian Information

Emergency Contact Information

Focus Groups Selection

Permissions

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