SUMMER Musication Camp Registration Lefferts Gardens Location ( 21 Lincoln Road )
PLEASE MAKE SURE TO MAKE PAYMENT ON PAYMENT PAGE TO COMPLETE REGISTRATION
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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How did you hear about Musication Camp?
Choose the week(s) of Summer Musication Camp you would like to attend
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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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