Junior Acting & Film-Maker Summer Camp
June, July and August 2018
Email address *
Panorama Film AcadeME 小电影人夏季培训班
*Required
学生姓名 Student Name *
Your answer
家庭电话 home phone *
Your answer
性 别 gender *
Required
出生日期 birthday *
Your answer
目前学校名称 Current School Name *
Your answer
年级 grade (2018fall) *
Your answer
特长及兴趣 talent and interest
Your answer
夏令营时段第一选择 Your First Choice *
Required
夏令营第二选择 Your Second Choice *
Required
夏令营第三选择 Your Third Choice
是否需要9点以前或5:00以后儿童看护? Yes or no Extended Care (8-9am) and (4:30-5:30pm)? The extended care cost is $20 per week. *
Required
是否对食物、昆虫、花粉等过敏?请解释。 Yes or no any allergy to food, insects or pollen? Please specify. *
Your answer
家庭情况信息 Family information
<微信号>为了更好地为您服务并提供咨询,请提供您的微信号, 以便把您加入学校的微信群, 谢谢!To better serve you and your family, please provide us with your WeChat ID, so we can add you to the school WeChat Group.
Your answer
家中有几个孩子报名参加?How many siblings of your family sign up for our camp? *
家庭地址 home address: *
Your answer
父母(监护人)姓名及手机号 Parents' name & contact number: *
Your answer
1. Chase QuickPay ----- Pay to: panoramahouston@gmail.com 请在备注中注明学生的英文全名、家长联系方式及课程期号。2. 支票 Check ----- Pay to: Panorama Film AcadeME *Note:$395/week, $790/session; You can pay tuition by per session or per week. *
Your answer
紧急联系人及方式(父母以外)Emergency Contact name & number (in case the parents can not be reached) : *
Your answer
医生姓名及电话 The Doctor's name and number *
Your answer
你通过何种渠道知道我们的?How did you hear about us? *
1. Chase QuickPay ----- Pay to: panoramahouston@gmail.com 请在备注中注明学生的英文全名、家长联系方式及课程期号。2. 支票 Check ----- Pay to: Panorama Film AcadeME *注:$395/周, $790/期; You can pay tuition by per session or per week.
另:One-time sign up fee: $25 per kid and $40 for 2+siblings ONLY.
报名费$25,两个及以上siblings总共$40。
Your lunch fee and registration fee will be waived if you pay by 5/1/2018.
5/1之前交全款者减免午餐($50)及报名费, 并享有零食和水等。
交钱方式 payment *
Waiver and Release Form for SUMMER CAMP: I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to me as a result of participation in said event. This release is intended to discharge in advance Panorama Film AcadeME, its officials, officers, employees, volunteers and agents from liability even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assignees.Film AcadeME. Teachers may display students’ work/photo in school or limited e-release(Website or WeChat) as recognition of student achievement. *
Required
Waiver and Release Form for Summer Camp & Photo Release Form for Minor Children: I hereby authorize Panorama Film AcadeME to publish the photographs taken of me and/or the undersigned minor children, and our. names, for use in the PanoramaFilm website and for display in the facility. I release Panorama Film AcadeME from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent of legal guardian of the children listed below and that I have the authority to authorize Panorama Film AcadeME to use their photographs and names. I acknowledge that since participation in publications and websites produced by Panorama Film AcadeME is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced by Panorama Film AcadeME confers no rights of ownership whatsoever. I release Panorama Film AcadeME, its contractors and its employees from liability for any claims by me or any third part in connection with my participation or the participation of the undersigned minor children. *
Required
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