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: