EmailMe Form - 2016 Summer Dance Camp Form (Laf)

Which week are you registering for? *
Camper *
First Last
Primary Emergency Contact
(Parent/Guardian) *
First Last
Phone 1 *
### - ### - ####
Phone 2 *
### - ### - ####
Secondary Emergency Contact *
First Last
Phone 1 *
### - ### - ####
Phone 2
### - ### - ####
HEALTH INFORMATION
Permission to Seek Medical Attention *
Yes
Checking "Yes" authorizes Kids 'N Dance 'N Theater Arts to seek emergency medical attention for the above named camper
List any pertinent health concerns:

-allergies
-medication
-special needs
-PLEASE NOTIFY IF EPI PEN IS NEEDED
I am aware that families are asked to pack lunches and snacks free of peanuts and tree nuts including those that may have traces of nuts. *
Yes
If campers inadvertently bring nut products to camp, they will be asked to eat one of our nut free snacks instead. We apologize for the inconvenience and appreciate your support in helping create a safe environment for all campers. If your child has a nut allergy, it is still important that you notify staff and inform us whether an epi pen is to be supplied.
Is there anything else we might need to know about your child?

-social / emotional needs
We want your child to have the best possible experience. Is there anything we should know about your child that will help us know what their needs are?
SOME LOGISTICS
Is your child registered for both the morning and afternoon camp requiring supervision from 1:00-1:30? *
Yes
No
If yes, please pack an extra snack.
PICK-UP POLICY

Campers can be picked up in the 15 minute window BEFORE camp ends. We appreciate you making every effort to pick up your child on time because teachers have other responsibilities after camp. Charges of $1/minute will accrue after the 15 minute window of time to pick-up campers.
I understand that if I am late to pick up my child, my credit card on file will be charged $1/min *
Yes
Release of Liability *
Yes
Checking "Yes" indicates you agree to the following: I voluntarily enroll my child with full knowledge that there is risk of personal injury in any activity affiliated with KND. I agree neither I, my heirs, assigns or legal representatives will sue or make any other claims against Kids N Dance/Onstage, its members or employees for any degree of personal injury, property damage/loss, regardless of cause.
Publicity *
Yes
Checking "Yes" indicates you agree to the following: I grant Kids ‘N Dance / Onstage representatives and employees the right to photograph or digitally record rehearsals or shows and authorize them to copyright, use and publish them.
HELP US HELP OTHERS FIND OUT ABOUT US
How did you find out about our program?
*
Kids 'N Dance Fan
Facebook Advertisement
Email Newsletter via Kids 'N Dance
On-line Camp Listing
General Internet Search
Friend
Other (please specify)
Person completing this form *
First Last
Signature of parent/guardian who completed this form *
Clear
Use your mouse or touch pad to electronically sign.

HEALTH INFORMATION

SOME LOGISTICS

PICK-UP POLICY

HELP US HELP OTHERS FIND OUT ABOUT US