SILENT WEEKEND REGISTRATION FORM .                                         

In consideration of my being allowed to participate in the “Silent Weekend” sponsored by

Columbus State Community College (CSCC),

I hereby release CSCC from all responsibility for any injury which occurs to me or to any of my property while I am involved as a guest in this activity. 

I also consent to CSCC using any photographs or video of me at the activity for public relations or related purposes.  I further agree to pay to CSCC any sum of money that CSCC may be compelled to pay  because of my participation in the above named activity.

 

CIRCLE all that apply:      

DEAF     HEARING       CSCC STUDENT      CSCC Fac/Staff       This is my FIRST Silent Weekend          I am AGE 18 or older     Other

 

Signature                                                                                                                                        Date                                              

Please PRINT:  Full name:                                                                                                           Phone                                                 text/voice

Name (as you want it on your name tag)                                                                                                         

 

Address                                                                                                                                                                  Email                                              

 

Registration for Indian Lake NOW OPEN!!

Silent Weekend #115 Tee Shirt Preference:

I am interested in buying the Summer SW 115 Limited Edition Tee Shirt.      Yes        No     Size ______  (Indicate S,  M,  L,  XL,  XX)

Bring cash to the weekend to purchase your tie-dye tee at the camp registration table. Pay when you pick it up. 

             

 Mail this form and $25.00 to:  Chris Evenson - 219B Union Hall, Columbus State Community College

                                                 P. O. Box 1609,  Columbus, OH  43216-1609                 

(PLEASE make checks payable to C.S.C.C.)

Registration for Indian Lake NOW OPEN!!