EmailMe Form - 2016 Camp CIT Information Form (Oak)

Please complete this form only when the registering CIT is available, as they will be required to answer a few questions at the end of the form. You can not complete it partially and then return to complete it at a later time.

Which camp are you attending as a CIT? *

Please enter camp NAME and DATES.

Camper *

First Last

Primary Emergency Contact
(Parent/Guardian) *

First Last

Phone 1 *

### - ### - ####

Phone 2 *

### - ### - ####

Secondary Emergency Contact *

First Last

Phone 1 *

### - ### - ####

Phone 2

### - ### - ####

PICK UP INFORMATION -

CIT's are dismissed 15 minutes after the camp is over to allow time to help with sign out de-briefing with the instructor.

We appreciate you making every effort to pick up on time. Extended care must be arranged 24 hrs in advance to avoid $1/minute late charges.

I understand that if I am late to pick up my child, my credit card on file will be charged $1/min *

Yes

EXTENDED CARE

- Registration required 24 hours in advance. Staffing may not otherwise be available.
- Register on-line, by calling, or in person
- $10/hr (8:30-9:00/12:00-1:00/4:00-5:00/5:00-6:00)
- Reservations are in one hour increments with the exception of early care
- No refunds

I need extended care *

Yes

No

I believe I have already paid and registered for extended care *

Does Not Apply

Yes, I have already registered for extended care

No. I have not YET registered, but I understand that I must pre-register a FULL 24 HOURS NOTICE IN ADVANCE

HEALTH INFORMATION

Permission Given to
Seek Medical Attention *

Yes

Checking "Yes" authorizes Kids 'N Dance 'N Theater Arts to seek emergency medical attention for the above camper. As the parent or authorized representative, I hereby give consent to Kids N Dance N Theater Arts to obtain Medical or Dental care prescribed by a duly licensed physician (MD) or dentist (DDS). This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of the child named above.

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.

List any pertinent health concerns:
- allergies
- medication
- special needs
- NOTIFY OF EPI PEN NEEDS

All medications must be provided to the staff and administering directions must be detailed here PLEASE CONFIRM NOTIFICATION AT SIGN IN

Is there anything else we might need to know about your camper?

We want your child to have the best possible experience at camp. Is there anything we should know about your child that will help us know what their needs are?

SOME LOGISTICS

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. Names will never be used

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.

FOR THE CIT CAMPER TO COMPLETE

We would like to get to know our CIT's prior to camp. Please ask them to complete this portion of our form.

SCALE RATING

There are so many interesting aspects of theater. We want to find out what interests you the most. Our goal is to give you experience in at least two of your favorite areas.

Choreography

Very Interested

1

2

3

Less Interested

Acting/Blocking

Very Interested

1

2

3

Less Interested

Set Design

Very Interested

1

2

3

Less Interested

Sound/Lighting Design & Exectution

Very Interested

1

2

3

Less Interested

Costuming

Very Interested

1

2

3

Less Interested

Please tell us what experiences you have had in dance or musical theater. *

Please describe your experience working with children *

What positions of responsibility or leadership have you had in the past? *

HELPS US HELP OTHERS FIND OUT ABOUT US

How did you find out about our camp?

*

Adult completing this form *

First Last

Signature of parent/guardian who completed this form *

Clear

Use your mouse or touchpad to sign electronically.