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Register for the Program for Children & Youth at the 2012 NACAC Conference

This registration form is for children and youth only. If you need to register adults, click here. Please register adults before registering accompanying children.

If you are paying by credit card, you can complete the form below to register for the children's programming at the NACAC conference. If you are paying by check or money order, you can download a PDF version of the form to complete and return with your payment.

Please note that you cannot save your registration part way through, so you must be ready to complete it fully before you begin the registration process.

You should receive an e-mail confirmation of your registration within two weeks. If you do not receive a confirmation, please contact us at info@nacac.org or 651-644-3036.

Registrant Information | Parents or Guardians

E-mail Address
First Name
Last Name
Affiliation
Cell Phone
Hotel Staying At
Parenting Partner's Last Name (if attending)
Parenting Partner's First Name (if attending)
Partner's E-mail Address
Driver's License # of person picking child up (for security reasons)

Child/Youth Information

If you are registering more than two children, you may submit multiple forms.

Child/Youth 1
Child/Youth Name
Age as of July 26, 2012
Gender
Child/Youth's Current Medications

Please note that the child/youth program staff do not administer medication, but can carry the medicine and remind the child/youth when to take it.

Special Arrangements (all information confidential)
Behavioral issues
Allergy, diet, or transportation requirement
Other

I agree to hold the North American Council on Adoptable Children (NACAC) and its officials, employees, volunteers, and children/youth program staff and volunteers, harmless from and against claims, damages, losses, and expenses of any kind whatsoever, arising out of the placement of my child/youth in their care, during my attendance at the NACAC conference, July 26–28, 2012.

Parent or Guardian Name:
Date:

Permissions

I certify that I am (check one):
the legal parent/guardian of the above child/youth
the foster parent of the above child/youth (Please do not grant photo or medical permissions below for foster children.)

I, the undersigned parent or guardian of the child/youth listed above,

  • give permission for him/her to participate in program activites. If the child/youth listed above requires medical attention,
    • I do / do not (check one) give permission to any doctor or hospital to commence treatment in the event I cannot be contacted and agree to assume any financial obligation in connection with such medical treatment
  • understand that my child/youth may be photographed by NACAC staff, NACAC's conference photographer, or child/youth program staff.
    • I do / do not (check one) give NACAC and C.A.S.E. permission to use my child’s photo in their newsletters, annual reports, or other adoption-related publications, or for other permanency-related promotions (Please do not grant permission for foster children)
  • understand that I may be asked to remove my child/youth from the program if a discipline problem arises that has an adverse effect on other participants. If this happens, my child care fees (pro-rated by day, if applicable) will be reimbursed.

Parent or Guardian Name:
Date:

 

Child/Youth 2
Child/Youth Name
Age as of July 26, 2012
Gender
Child/Youth's Current Medications

Please note that the child/youth program staff do not administer medication, but can carry the medicine and remind the child/youth when to take it.

Special Arrangements (all information confidential)
Behavioral issues
Allergy, diet, or transportation requirement
Other

 

I agree to hold the North American Council on Adoptable Children (NACAC) and its officials, employees, volunteers, and children/youth program staff and volunteers, harmless from and against claims, damages, losses, and expenses of any kind whatsoever, arising out of the placement of my child/youth in their care, during my attendance at the NACAC conference, July 26–28, 2012.

Parent or Guardian Name:
Date:

 

Permissions

I certify that I am (check one):
the legal parent/guardian of the above child/youth
the foster parent of the above child/youth (Please do not grant photo or medical permissions below for foster children.)

I, the undersigned parent or guardian of the child/youth listed above,

  • give permission for him/her to participate in program activites. If the child/youth listed above requires medical attention,
    • I do / do not (check one) give permission to any doctor or hospital to commence treatment in the event I cannot be contacted and agree to assume any financial obligation in connection with such medical treatment
  • understand that my child/youth may be photographed by NACAC staff, NACAC's conference photographer, or child/youth program staff.
    • I do / do not (check one) give NACAC and C.A.S.E. permission to use my child’s photo in their newsletters, annual reports, or other adoption-related publications, or for other permanency-related promotions (Please do not grant permission for foster children)
  • understand that I may be asked to remove my child/youth from the program if a discipline problem arises that has an adverse effect on other participants. If this happens, my child care fees (pro-rated by day, if applicable) will be reimbursed.

Parent or Guardian Name:
Date:

 

 

 

Payment

Fee: $175 per child

Please note that Canadian credit cards will be charged in US dollars.

Children Registered x $175
*Amount Due
*Name on Credit Card:
*Credit Card Type:
*Credit Card Number:
*Expiration Date: Month Year
Billing Zip Code
3-Digit Code on Back
Comments:
*required fields

Additional Information

We will forward information about staff-to-child ratios and daily activities upon receipt of this form and fees. At the conference, children will be released from the program to a parent or guardian only.

Lunch will be provided on Thursday, Friday, and Saturday. Morning and afternoon snacks will be provided throughout the program. If your child has special dietary requirements, you must bring appropriate meals and snacks each day.

 

 

 
North American Council on Adoptable Children (NACAC)
970 Raymond Avenue, Suite 106
St. Paul, MN 55114
phone: 651-644-3036
fax: 651-644-9848
e-mail: info@nacac.org
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