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:   HEARING       DEAF      CURRENT CSCC STUDENT       OTHER _____________       

 

To help us order shirts and correct sizes:

I am interested in buying the SW 106 Shirt.      Yes        No     Size ______

            Shirts will be available at the camp registration table. Pay when you pick it up. 

 

Signature  _________________________________________________date _____________                   

 

PLEASE PRINT:   Name ____________________________________   (as you want it on your name tag)

Address ________________________________________________________________________    

  

Phone ___________________________ TEXT   VOICE

e-mail ___________________________

 

 Mail this form and $25  to:  Gayle Murphy - 211 Union Hall, Columbus State Community College

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

(PLEASE write checks to C.S.C.C.)