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Incarnate Word Academy Lab Adventures Camp Session I

Location: Incarnate Word Academy, 609 Crawford Street, Houston, Texas 77002

Camp Dates: June 12, 2023 - June 16, 2023 Times 1pm - 4pm

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By signing this form, we (I) certify that we (I) request and give permission for our (or my) daughter to take part in IWA’s Summer Camp.

We (I) hereby release Incarnate Word Academy and all its employees and agents from all claims on account of any injuries which may be sustained by our (or my) daughter while traveling to and from and visiting the Incarnate Word Academy campus, and its employees and agents (volunteers or students) for any claim which may be hereafter presented by our (or my) minor daughter.

Additionally, I authorize Incarnate Word Academy to any of its employees to secure medical treatment for my daughter in the event of an emergency, accident or illness.

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Media Release*

We (I) consent and give permission to Incarnate Word Academy and its affiliates to use photographs and/or images of our daughter in publications, media, public relations, fundraising and recruiting material. We (I) do not want our daughter's image to be used in publications or any other media.

By selecting "I agree" below, I agree to the terms listed and I am certifying that the information listed above is accurate and complete.*

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Emergency Information

Please list the name of an emergency contact in the event that a parent cannot be reached during an emergency.

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