2019 Summer @ Live Arts Camp Registration and Permission Form for Mini Camps A (Ages 4-5) and B (Ages 6-7)
Your registration for Summer 2019 @ Live Arts Camp is complete once you fill out this form and also submit payment. Please complete this form for each child you are registering. If you are registering the same child for multiple Mini Camps, you need only fill out this form once.

*YOUR CHILD IS NOT OFFICIALLY REGISTERED FOR A LIVE ARTS CAMP UNLESS YOU HAVE ALSO PAID CAMP TUITION THROUGH OUR TICKETING SYSTEM.*

Liability Release Form *
*My child has my permission to participate in the Live Arts Summer Camp. I understand that I am responsible for any damage to property or persons resulting from my child's actions. I understand that consumption or possession of alcohol or illegal drugs is not permitted. I give permission for Live Arts staff to call for emergency medical services in the event that I or the emergency contact person cannot be reached and before contacting me if the Live Arts personnel deem it appropriate. I hereby release and agree to indemnify and hold harmless Live Arts, its agents, employees, officers, and directors from any and all responsibilities and liability for injuries to my child while enrolled in a Live Arts Camp.
Name of Child registered *
Your answer
Age of child *
Your answer
What school does the child attend (if applicable)? *
Your answer
My child will enter the following grade in the fall *
Please indicate which Summer Camp(s) you are registering for *
Check all that apply!
Required
Name of Parent/Guardian *
Your answer
Relationship to child *
Your answer
Cell # *
Your answer
Home #
Your answer
Work #
Your answer
Email *
Your answer
Name of Second Parent/Guardian (if applicable)
Your answer
Second Parent/Guardian Relationship to Child (if applicable)
Your answer
Second Parent/Guardian Cell # (if applicable)
Your answer
Second Parent/Guardian Email (if applicable)
Your answer
Please list any other person who is authorized to pick up you child, if applicable:
Your answer
Emergency Authorization and Consent for Summer Camp *
I/We undersigned parents or legal guardians of the minor registered do hereby give authorization and consent for medical treatment in the event my child becomes ill or injured during a Live Arts summer camp. Live Arts Staff or volunteers are authorized to take one or more of the following actions: a) provide reasonable basic first aid; b) release my child to the person listed below; c) take my child to a physician or call the physician indicated; or, d) take my child to the hospital and/or give consent for emergency care.
Person in addition to parent or guardian to contact in emergency (and relationship to minor) *
Your answer
Cell # *
Your answer
Home #
Your answer
Work #
Your answer
Doctor's Name *
Your answer
Doctor's Office Address *
Your answer
Doctor's Phone # *
Your answer
Please indicate any significant health history of which Live Arts should be aware
Your answer
Please list all allergies, dietary restrictions, and/or medications *
Your answer
Does your child have any special needs, (behavioral, medical, emotional, etc.), we should be aware of to help your child have a safe and positive camp experience?
If you answered yes to the above question, a Live Arts summer staff member will call prior to your camper's arrival to discuss how we can best help your camper to have a positive experience. Please indicate below that you understand and agree to be contacted.
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