Music Camp Registration Form

    STUDENT INFORMATION

    Student Name: Last First

    Grade entering in the Fall 3456789

    School attending in the Fall

    Main instrument         Years of experience

    Address City Zip code

    PARENT/GUARDIAN INFORMATION

    Parent/guardian name Cell phone Other phone

    Parent/guardian name Cell phone Other phone

    Parent/Guardian Email Address

    Emergency contact name(Photo ID required) Home phone Cell

    Other adults authorized to pick up your child

    MEDICAL INFORMATION

    Please list allergies

    Best person to contact in case of emergency Phone

    Insurance provider

    FOR CAMP PLANNING

    Camp T-shirt size (choose one) youth Myouth Lyouth XLadult Sadult Madult Ladult XL

    How did you find out about us? (Check all that apply)
    Returning camperSchool flyerFriendlocal advertisingOther (please indicate)

    LIABILITY/INJURY WAIVER AND RELEASE -- PHOTO RELEASE

    The undersigned as parent/guardian hereby gives permission for his or her child to attend all events described by the Kiwanis Club of Cambrian Park Summer Music Camp.  The undersigned agrees not to hold the Kiwanis Club of Cambrian Park Summer Music Camp, its directors and employees liable for any injury suffered by the participants attending the camp.  The undersigned also allows the child to receive emergency medical care if needed.  It is the understanding of the undersigned that refund or credit will not be given once the camp is in session.  The undersigned acknowledges that disruptive behavior during camp could result in my child being asked to leave camp

    The Kiwanis Club of Cambrian Park has my permission to use photographs which include my child participating in Summer Music Camp for use on its web site and informational brochures.

    Please CHECK ONE  YesNo

    Parent/Legal Guardian Name Date: