Babysitter Camp Please select your location:*TucsonPhoenixDallas Fort-WorthCamper InformationCampers' Name:* First Last Age:* Gender* Parent InformationName* First Last Cell:* Home/Work:* Email* Does your child have any allergies, medical conditions or special needs we should be aware of?*Please list your child's activities, interests and hobbies.Please tell us anything else we should know/you would like us to know about your child. We want to provide the best possible camp experience!In Case of An EmergencyEmergency contacts should be adults other than parents and at least one should be local, if possible.Emergency Contact Name:*This should be someone local, other than the parent(s)/guardian(s)/client(s) already listed. Best Contact Number:* Relationship Emergency Contact 2 Name:This should be someone local, other than the parent(s)/guardian(s)/client(s) already listed. Best Contact Number: Relationship PaymentPlease agree to the terms and conditions below.* I understand that I will be charged an $145, non-refundable camp registration fee upon submitting this form. Camp starts promptly at 9am each day and ends at 4pm. Camp cost does not include a lunch. Campers should bring their own lunch. Special Promo Code: HiddenPlease select payment option:* ACH/Bank Account ** (Recommended, see below) Credit/Debit Card **ACH transfers are inherently more secure. When you make an ACH payment, it processes through an encrypted, secure system. The payment is then processed in a safe, secure environment, giving your credentials increased protection.Registration ChargeTotal $0.00 ACH/BANK ACCOUNTCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country WaiverI hereby permit Trusting Connections, LLC to provide care to my child and agree, in conjunction with my participation in TC's Babysitting Bootcamp, to release and hold harmless Trusting Connections, LLC, its officers, trustees, agents, and employees, from any and all claims, demands, suits, costs and charges, in connections with or arising out of the camp program, including, but not limited to, bodily harm or injury to my child(ren), except only for loss, harms or injury occasioned by gross negligence or intentional misconduct by a Trusting Connections employee. In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize Trusting Connections to engage emergency services to provide necessary medical treatment. I also understand and agree that TC may take photos of the camp experience which may or may not be used for future promotional materials. Signature*Date* Month Day Year CAPTCHAEmailThis field is for validation purposes and should be left unchanged.