Bridgehampton Registration - Rock Camp
Please answer each question and write "N/A" when necessary.
Camp Session - Please select all that apply.
Session 1: July 16th - 20th
Full Day, 9:00-3:00
Age as of June 1, 2018
List student's instrument(s) and number of years of study.
Please list any food allergies or medical conditions we should be aware of.
Home Phone Number
Mother's Cell Phone
Mother's Work Phone
Father's Cell Phone
Father's Work Phone
Name of Emergency Contact
Emergency Contact Phone Number
Please List the Names of People Who Can Pick Up Your Child.
If Your Child is of Driving Age, Does He/She have Permission to Drive to and from Campus?
Does Your Child have Permission to Leave Campus Temporarily to Pick Up Lunch?
Please Type Your Name in Place of a Signature
I hereby waive and release any and all full rights and claims for damages I may have against Grooveaholic Music LLC (dba Rock Camp, dba Hudson Music Studios), Acorn Montessori School, Stephen Hudson, staff musicians, for any and all injuries sustained by the attending student or students listed above, including transportation to and from our music program in connection with any participation in this music program. I so hereby give my consent to medical emergency or otherwise, inclusive of necessary transportation, in order to receive treatment in the event of injury or any other illness with my child.
Please Check the Box Below to Agree to this Statement.
I give permission for my child to be photographed, filmed, interviewed and have work samples published in print and/or on the Internet for Rock Camp (Grooveaholic Music LLC) or Acorn Montessori School for promotional purposes.
How Did You Hear About Rock Camp/Dance Intensive?
Brochure/Flyer in Your Area
The East Hampton Star
Chase Edwards Gallery
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service