Summer Arts Camp REGISTRATION FORM
Session Two- July 17-28 - "Focus on Dance" Ages 8 -16
Parent's Name:
Street Address:
City:
Prov. :
Postal
Code :
E-mail:
E-mail
validation:
Home
Phone:
Cell :
  
Emergency
Contact Person:
(name and relationship)
Emergency
Contact Info:



Current Age:
First Camper's Name:
Grade level:
Medical Card #.
Allergies (food, medicine, etc) :

Second Camper's Name:
Current Age:
Grade level:
Allergies (food, medicine, etc) :
Additional Information/ Comments (i.e. existing medical conditions, medications, etc):
Third Camper's Name:
Current Age:
Medical Card #.
Grade level:
Additional Information/ Comments (i.e. existing medical conditions, medications, etc):
Additional Information/ Comments (i.e. existing medical conditions, medications, etc):
Are their any other issues, or other concerns, that we should be aware of?:
Allergies (food, medicine, etc) :
Medical Card #.
Consent and Release
Indicated in the space(s) above are any health problems or conditions of which the animators should be aware
(such as heart, back, medical, allergy, muscular, diabetes, epilepsy, special medication, joint problems, etc.). I
understand that risk of injury is inherent in any physical activity and I, on behalf of myself and my child, knowingly
and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, hereby
waive and release the animators, Mark and Tina Bye individually and the Rural Arts Project, Grove Hall and its staff
from any and all claims or damages of any kind arising out of my child's participation in the arts camp.

I further certify that the aforementioned student is in proper physical condition to participate in the arts camp
program. I, the undersigned, do hereby authorize Mark Bye, Tina Bye, the animators or their designated agents to
obtain medical treatment for my child in emergency situations where I cannot be reached in time to authorize the
treating physician to provide such emergency medical services.

I give permission to the Rural Arts Project and Grove Hall to use photos and videos taken in the process of the
classes in future promotions (posters, website, advertising etc.)
By Clicking Here I agree to the above Consent and Release Statement