SILENT WEEKEND #113 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/STAFF       OTHER        

This is my first Silent Weekend ____.                  I have been to  ___ Silent Weekends.

 

 

I am interested in buying the Winter SW 113 Sweat Shirt.      Yes        No     Size ______

Pay CASH for shirts on arrival to camp.  Limited quantities/sizes ordered - first come, first served!

 

Your SECRET:                                                                                                                                                               (Write something about yourself that nobody at Silent Weekend knows. This will be used for a "get acquainted" activity!)   

 

Signature  _________________________________________________Date _____________                   

 

PLEASE PRINT:  

Name ____________________________________________   (as you want it on your name tag)

 

Address________________________________________________________________________    

  

Phone ___________________________ TEXT   VOICE

e-mail ___________________________

 

 Mail this form and $60.00  to:  Gayle Murphy - 219 Union Hall, Columbus State Community College

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

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

Registration OPEN!!