Condon Arts Council Summer Program Sign Up
Please complete this form to register your child for one or both of the 2021 CAC Summer Art Programs: the Polynesian Cultural Arts Camp held July 23-25th and or the Performing Arts Workshop held July 30- August 1st. Each camp is $25. Information detailing drop off and pick up, class schedule, what to bring, lunch options, and teacher bios, will be sent to you via your contact email listed below.
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My child will attend the Polynesian Cultural Arts Camp July 23-25th *
Required
My child will attend the Performing Arts Camp July 30- August 1st. *
Required
Student Name *
Age *
Parent Name *
Contact Phone Number *
Email:
Name of Insurance Carrier *
Insurance Group Number *
Medical Consent: In presenting my child for diagnosis and treatment, I hereby voluntarily consent to the rendering of such care, including diagnostic procedures, surgical and medical treatment, etc. by authorized members of the clinic/hospital staff as may, in their professional judgement be necessary. *
I have read this form and verify that I understand its contents and acknowledge I (we) as the parent(s) are responsible for all reasonable charges in connection with care and treatment of my child. *
Required
Photo Release Permission: As a parent or guardian of this student, I hereby consent to the use of photographs/videotape taken during the coarse of the workshop for publicity, promotional and/or educational in purpose (including publications, presentation or broadcast via newspaper, internet, and or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or damages. *
I have read and signed the attached Acknowledgement of Risk and Waiver of Liability form.
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Parent Signature *
Date *
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