EmailMeForm
(OLDdo not use) LC 5 & 6 ANNUAL REGISTRATION 2017
**This annual registration is a required document for ALL participants.**
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Name
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First
Last
Session Attending
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LC5: June 28-June 30
LC 6: June 28-June 30
I may not be able to attend my summer session. I will contact Wyman to discuss my options.
*Please fill out the entire form even if you believe you are unable to attend.*
T-Shirt Size
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Small
Medium
Large
X-Large
XX-Large
What are your plans after high school?
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Attending college
Going into the military
Getting a job/working
Trade
Other
If you are attending college after high school, what school and what is your intended major/career?
Have you completed your FAFSA?
Choose one:
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Yes
No
If you are enlisting in the military, which branch will you be in?
Home Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Your Phone
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Your Email
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I, the undersigned, am over 18 and applying to participate in programs by Wyman during 2016. I am aware that there are potential hazards and risks involved in some programs. I am willingly participating in all aspects of the residential and/or day camp program (including field trips and transportation) under the supervision of Wyman staff.
Choose one:
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Yes
No
I give my consent to Wyman to use videos and/or photographs of me for brochures, to display in photo albums, advertisements or for other publicity purposes.
Choose one:
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Yes
No
If my photo is used, I may be identified by the following:
Photo only, no name
First name only
First and last name
Wyman seeks to support and stay updated on students and their academic progress. As such, we would like to track you through the NSC. I authorize the Wyman Teen Leadership Program to verify information reported to the National Student Clearinghouse (NSC) by schools I have attended.
Choose one:
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Yes
No
I, the undersigned, give permission for the above-named school to release all information regarding my academic and financial records to WYMAN for advising and tracking purposes. The release allows for verbal and written access as requested by myself and/or Wyman. All permissions granted will stay in effect during the admissions process and for the duration of my stay at the above-named school or until I revoke them in writing.
Choose one:
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Yes
No
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