Musication Camp SPRING Break Registration -Lefferts Gardens & Park Slope Location.
Students Name *
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Child's Age and Date Of Birth *
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Name Of School and Class/Grade Currently Attending *
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Parent/Caregiver's Name(s) *
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Cell and Work Phone *
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Email Address *
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Please list any allergies or special conditions we should be aware of, please include if your child has any special needs or currently has SEIT. (if none, write "none") *
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List 2 emergency contacts, names and numbers. *
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Please list names of all authorized people picking up your child. *
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Please check the box below for the desired location. *
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I, the undersigned give permission for my child to participate in all Musication Camp activities for the days he/she attends. I understand that no refund or credit will be given for missed days. I understand that I must have a completed medical form on file BEFORE the first day of the music camp program. I also hereby give authority to the staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. DISCLAIMER: It is understood and expressly agreed to by the Parent/Guardian that by registering, making payment and/or participating in a Musication program, the Parent/ Guardian releases, indemnifies, and holds harmless Musication Inc and its' owner, staff and employees from any liability of any kind for damages and/or injuries incurred in connection with the students and parents in attendance at Musication Camp. *
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I agree my spot is not secured until payment is made. Please check box and we will send you an invoice. *
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