March Break 2019 Registration
By electronically submitting this form, I am authorizing the named participant below to take part in the full range of camp activities offered. In the case of injury or accident of any kind at the 2019 March Break Art Explosion Camp, neither Guelph Dance (GD) or the River Run Centre (RRC), nor any employee, nor volunteer of GD or the RRC will be held liable for the occurrence. I hereby release GD and the RRC, its employees or volunteers from all claims or damage, which may arise out of any loss or personal injury to the named participant in this program.
1. Camper's First Name *
Your answer
2. Camper's Last Name *
Your answer
3. Camper's Date of Birth *
MM
/
DD
/
YYYY
4. Camper's current grade
Your answer
5. Medical Information/special needs *
Your answer
6. Full Mailing Address *
Your answer
7. Name of Parent of Guardian 1 *
Your answer
8. Email of Parent/Guardian 1 *
Your answer
9. Best Phone Number for Parent/Guardian 1 *
Your answer
10. Check here to consent to be added to our email list, which we use to notify about camps and other Guelph Dance events.
11. Name of Parent of Guardian 2
Your answer
12. Email of Parent/Guardian 2
Your answer
13. Best Phone Number for Parent/Guardian 2
Your answer
14. Check here to consent to be added to our email list, which we use to notify about camps and other Guelph Dance events.
15. CAMP PICKUP: Please indicate who is authorized to pick up your child, in addition to the above parent/guardian. NOTE: all authorized people must bring photo ID in order to pick up. your child. Please include Name *
Your answer
15 a. Phone number
Your answer
15 b. Relationship to the child
Your answer
16. Emergency Contact if parents/guardians cannot be reached? *
Your answer
16 a. Phone number for Emergency Contact *
Your answer
17. Do you want to register your child for after-care ($25 for the week from 4:30 to 5:30 pm Monday to Thursday) *
Required
18. I authorize that photos taken of my child by GD may be used for future camp promotions. *
Required
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This form was created inside of guelph contemporary dance festival.