Event Registration
Registration Form
CSC Fine Arts Summer Camp 2021
July 12 , 2021 - July 17, 2021

Landmark Ministries
6342 E. 71st Ave. | Commerce City, CO 80022|720-748-0955

(Especially designed for TWEENS - ages 9 - 14)
Sponsored by CSC, Landmark Ministries
Fee: $50.00 (Includes daily lunch and snack)
Email *
Student Name *
Nick Name *
Date of Birth : *
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Age: *
Grade:
Street Address: *
City: *
Zip Code: *
Guardian's Name *
Guardian Contact Number: *
Guardian's Contact Number
Emergency Contacts:
Please provide two (2) Emergency Contacts
Emergency Contacts Name:
Emergency Contact Number:
Relationship to Student *
Emergency Contacts Name:
Emergency Contact Number:
Relationship to Student *
Years/Description of Training (i.e art, musical training and performance: )
Medical Information
Allergies (please list all) :
MEDICATIONS (List below, with doses and times. Please write "none" if the student does not take any medication)
MEDICAL CONDITIONS including ADHD or any other behavioral conditions within the last 3 years.(Please write "none" if no medical conditions exist.)
Physician Name and Number
Insurance Name and Policy Number
Preferred Hospital
Additional Information (Please include information that will help us best serve the student, such as needs or behavioral concerns)
How did you hear about CSC Fine Arts Camp
Dietary restrictions *
I understand that I will have to pay $50.00 before the first day of camp to secure registration. *
Required
I understand that dance students take dance classes at their own risk and that neither Colorado Sisterhood Crusade or any teacher or staff member is liable for any injury a student may sustain during those classes. By registering with Colorado Sisterhood Crusade, I grant Colorado Sisterhood Crusade the right to use images/photographs taken during class or other Colorado Sisterhood Crusade activities for advertising or promotional purposes. I have read the above-referenced disclaimer and I understand and agree to, the registration fee, refund policy, withdrawal policy, late fees, class schedule, and other policies outlined therein. *
Required
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