Facets Academy - Camp 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?
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Film 101 (Facets Kids Film Camp):
Hitchcock Film Camp
Advanced Filmmaking (ProPath) - Ages 8-11
Advanced Filmmaking (ProPath) - Ages 12-15
Animation Film Camp
Payment Amount:
Payment Information:
Credit Card Number (to be charged):
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Credit Card Expiration Date:
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Credit Card CVV/CVV2 # (on back of card):
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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:
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