Registration is on a first-come/first-served basis. Space is limited. You will receive a confirmation of enrollment. Return this registration form and payment to:
TechKnowHow,
553 Pilgrim Drive Suite D, Foster City CA 94404
If paying by check, make check out to TechKnowHow, Inc.
Student’s Name: ______________________________________ Age: _____ Birth Date: ____________
Address: __________________________________________________________________________
Parent(s) Name(s): _________________________________________________________________
Daytime Phone Number: _______________________________________
Emergency/Cell #(s): __________________________________________
T-Shirt Size Youth Small - Medium - Large ______________________
My child's participation in the camps selected is voluntary. I understand that the selected activities, including recess
and lunch time and activities, may involve accidental injury and hereby voluntarily assume such risks. Knowing these
risks, I want my child to participate in this activity. I (on behalf of my child) hereby assume the risk, and hereby waive,
release, and discharge TechKnowHow, Inc., its officers, employees, activity instructors and assistants, and all
officers and employees of the school or community center sites where said activity will take place, for any and all
claims for damages for personal injuries, or claims for damages to property, which my child or my child's heirs,
assigns, executors or administrators may have or which may accrue to my child's participation in this activity. I have
read the above and understand important legal rights are being waived.
Signature (required) ___________________________________________ Date: ________________
I consent to TechKnowHow Inc.'s use of any photographs or videorecording that are taken of my child
while participating in the camp activity for use in TechKnowHow's brochures and program materials that are
distributed both as printed document and on the internet. No payment will be made for use of these photographs
and/or videos. Your child's name would never be used in connection with these images.
Signature (required) ___________________________________________ Date: ________________
Does the student have any allergies or medical condition?
Yes _____ No _____ If yes, describe:_________________________________________________
Email address (for enrollment confirmation):___________________________________________
Class(es) Desired: Location: ________________________
Class(es): __________________________ Dates/Time: __________________________ Tuition: _________
Class(es): __________________________ Dates/Time: __________________________ Tuition: _________
Class(es): __________________________ Dates/Time: __________________________ Tuition: _________
Class(es): __________________________ Dates/Time: __________________________ Tuition: _________
......................................................................................................Total: __________
If paying by credit card - Mastercard ________ Visa ______
Credit Card Number: __________________________________ Exp. Date: ________________
Card Id. # (Last 3 digits in the signature box on back of card) ________________
THIS IS REQUIRED TO PROCESS!!
Name on Credit Card: _________________________________
Address for Credit Card Billing (If different from address above):
______________________________________________________________________________
______________________________________________________________________________
......................................................................................................
Emergency Medical Information
Emergency Contact First Name:
____________________________________________________________
Emergency Contact Last Name:
____________________________________________________________
Emergency Contact Phone Number:
____________________________________________________________
In the event of an emergency, we will attempt to contact you as well as 911 Paramedics.
Please indicate choice of hospital and address:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Child's Medical Insurer: __________________________________
Child's Medical ID/Insurance Number: __________________________________
I authorize TechKnowHow Inc. staff to arrange transportation in case of accident
or acute illness and to arrange for possible emergency medical and,or surgical care
at the hospital listed above.
It is understood that an effort will be made to notify me at the above phone numbers.
If above such action is taken, and it is impossible to locate me or the above named,
the uninsured responsibility and expense of this service will be accepted by me.
Parent Signature ______________________________________________ Date _____________
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