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SHREKtacular Summer Camp - Session 2
June 10-13 - 1:30 - 3:30
Name: *
Your answer
Grade: *
School You Attend
Your answer
Birthday *
MM
/
DD
/
YYYY
Age: *
Your answer
Gender *
Email Address: *
Your answer
Parent's Names: *
Your answer
Main Phone Number: *
Please add a main contact number in case we need to contact you.
Your answer
Secondary Phone Number:
Please add a 2nd number in case of emergency.
Your answer
I understand there is a Participation Fee and understand I am not registered until this fee has been paid. Payment can be made online at www.CCCMT.org, click on make payment. *
If kids are put into groups, I want to be the same group as the following kids:
Your answer
I understand that communication is made via email and I will check my email regularly for notifications. I will email info@cccmt.org if I am not receiving emails. *
I declare that I am the parent or legal guardian of the above named child. In the event my child is injured or should require medical attention, I hereby request that you contact me or our emergency contact. In the event that we cannot be reached, I hereby authorize CCCMT to secure necessary medical treatment for my child. I further acknowledge that I will be responsible for any medical or hospital fees or costs associated with my child’s medical treatment. I assume all risks and hazards from participation in this production and hereby waive, release, absolve and indemnify and agree to hold harmless CCCMT , it’s organizers, sponsors, directors, volunteers, and participants for any claim arising out of accidental injury to my child. My signature below indicates that I have read, understand, and agree to the terms. *
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