Facets Academy - Summer Film School Application
Participant Name:
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Participant Age (as of August 31):
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Parent/Guardian Name:
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Address (Address/City/State/Zip):
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Cell Phone #1 (Parent/Guardian):
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Cell Phone #2 (Parent/Guardian):
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Other Phone (Home/Work):
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Email (Parent/Guardian):
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Emergency Contact other than yourself (name, relationship & phone):
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How did you hear about Facets Kids Film Camp?
Your answer
Facets Kids Film Camp:
Hitchcock Film Camp
Feminist Film Camp
Acting for Film
Pro-Path Film Camp:
Animation Film Camp
Payment Amount:
Payment Information:
Credit Card Number & Expiration Date (to be charged):
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Cardholder Name (Authorizing the Charge):
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Payment Notes:
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SIGN IN/OUT PERMISSION:
The following individuals have permission to sign my child in and out (Name & Relationship to Child):
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HEALTH CONCERNS:
Please detail health concerns (allergies, physical or mental challenges, chronic illnesses):
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Please detail action to be taken in regard to health concerns listed above:
Your answer
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