Virtual Pourquoi Tales Camp Registration Form (entering grades 6-10)
Questions? E-mail Kerith at hiphoptelestai@gmail.com
Email address *
Child's First & Last Name (use nickname if preferred) *
What Grade Level Is Your child Entering this Fall? *
Required
Has your child participated in any programs with Kerith Telestai in the past? (Check all that apply.)
If your child hasn't worked with Kerith Telestai in the past, how did you hear about Rising Stars?
Adult 1 Name *
Adult 1 E-mail *
Adult 1 Phone *
Adult 2 Name
Adult 2 E-mail
Adult 2 Phone
As far as art supplies go... *
Any health or learning notes for Kerith? (ADHD, autism spectrum, etc.)
I acknowledge that this camp carries a certain amount of risk, as would any online activity. In the event that my child should be injured, I assume all responsibility and will not hold Kerith Telestai liable. *
I give my permission for my child to be photographed/recorded WITH his/her first name attached in the final video and for the purposes of promoting this program. *
I understand that as a parent, I am expected to give support to my child as needed with technology, including connecting to our virtual platform, recording, and sending footage. *
Your registration is not complete without payment. Tuition cost is $60. Please pay Kerith Telestai through PayPal in order to secure your child's place. Thank you.
A copy of your responses will be emailed to the address you provided.
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