EmailMe Form - 2016 Summer Musical Theater Camp Form (Oak)

Which camp are you attending? *

Camper *

First Last

Primary Emergency Contact
(Parent/Guardian) *

First Last

Phone 1 *

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

Phone 2 *

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

Secondary Emergency Contact
(Parent/Guardian) *

First Last

Phone 1 *

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

Phone 2

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

Additional Persons that may be called in an emergency:

Name

Address

Phone

Relationship

Names of persons authorized to take child from the facility:

Name/s

Relationship

*Child will not be allowed to leave without authorization from parent or authorized representative

PICK UP INFORMATION - Camp Ends at 4:00 pick up starts at 3:45.

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. Extended care must be arranged 24 hrs in advance to avoid the late pick up 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 (8:30-9:00/4:00-5:00/5:00-6:00)
- 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 IN ADVANCE.

FIELD TRIP INFORMATION

Are you registered for the field trip? *

Yes

No

Permission given to
transport to field trip
location *

Yes

NOT ATTENDING Field Trip

Checking "Yes" authorizes Kids 'N Dance 'N Theater Arts to drive campers to off site locations.

Sun Screen Application *

Use camp sunscreen: Permission is given for you to apply spray sunscreen everywhere but on face. My child will apply their own face screen.

Please have my child self apply and use only their own sunscreen. Back and shoulders will be applied prior to camp.

We use Rocky Mountain Kids Sunscreen SPF 50

Swimming Ability *

My child is NOT water safe and needs to be in arms reach at all times (Campers will be required to wear life vest provided by the pool)

My child is somewhat water safe but should always stay in chest deep water

My child is very water safe and can confidently swim in deep water.

NOT ATTENDING field trip

We always actively supervise swimmers whether they are proficient swimmers or not. This information just helps us know appropriate limits for each swimmer.

Booster Seat Required? *

Yes

No, my child is 8 or older or is taller than 4'9"

NOT ATTENDING field trip

HEALTH INFORMATION

Permission Given to
Seek Medical Attention *

Yes

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.

List any pertinent health concerns:
- allergies
- medication
- diabetes, asthma, etc.
-PLEASE LIST IF CAMPER HAS EPI PEN

NOTE: All medications must be provided to the staff and directions for administering it to your child must detailed 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.

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.

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.

Can you help us for
10-15 min after the show
to break down our sets and
clean up? *

Sure, I'd be happy to help

Sorry, I can't help.

Producing shows on a weekly basis is a highly labor intensive process. A small contribution of putting chairs away, organizing costumes, and cleaning up the stage goes a long way AND it helps keep costs down. Please consider helping us out. We really appreciate it!

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?

HELPS US HELP OTHERS FIND OUT ABOUT US

How did you find out about our camp?

*

Person completing this form *

First Last

Signature of parent/guardian who completed this form

Clear

Use your mouse or touch pad to sign electronically