Bridgehampton Registration - Rock Camp
Please answer each question and write "N/A" when necessary.
Camp Session - Please select all that apply.
Student Name
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Age as of June 1, 2018
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List student's instrument(s) and number of years of study.
Your answer
Please list any food allergies or medical conditions we should be aware of.
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Street Address
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Home Phone Number
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Mother's Name
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Mother's Cell Phone
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Mother's Work Phone
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Mother's Email
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Father's Name
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Father's Cell Phone
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Father's Work Phone
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Father's Email
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Name of Emergency Contact
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Emergency Contact Phone Number
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Please List the Names of People Who Can Pick Up Your Child.
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If Your Child is of Driving Age, Does He/She have Permission to Drive to and from Campus?
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Does Your Child have Permission to Leave Campus Temporarily to Pick Up Lunch?
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Please Type Your Name in Place of a Signature
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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?
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