Camp Create Registration Form
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Pick a date to attend *
Required
Name of Child *
Age of Child *
Grade & School
Address *
Name of Parents *
Home Phone *
Cell Phone *
Please specify both Guardian's  cell numbers
Emergency Information
Please take a moment to complete your child's emergency information as accurately as possible
Emergency Contact *
First and Last Name
Relationship to Child *
Daytime Phone *
Medical Insurance Information *
Name of Insurance Company *
Policy/Group ID Number *
Additional Authorized Person(s) to Pick Up Child other than parent(s)
Please disclose any medical conditions, allergies or special needs for the child
Any Additional Information?
Medical Policy Information
My child has my permission to participate in all camp activities and is in good health.  I hereby, and for my heirs, executors, and administrators, assigns and all legal guardians, waive and release any and all rights and claims of any nature I may have against The Awakening Arts, its Directors, employees, Board of Directors, volunteers, and cooperating entities for and against any and all injuries and damages of any nature, which my child may suffer while taking part in Penny the Piano, Suzanne Jackson Studio, Camp Create or other activities associated with The Awakening Arts.    In case of a medical emergency, after every reasonable effort has been made to contact me or the child’s physician, I hereby give my permission to the Emergency Medical personnel contacted by The Awakening Arts to secure treatment for my child. I also authorize The Awakening Arts to provide a copy of this form to proper medical personnel for purposes of treating my child.  In the event that any such treatment is not covered by insurance applicable to the activities, I agree to pay all expenses incurred in such emergency treatment.    POLICIES & PROCEDURES As a parent, I have read all information concerning The Awakening Arts and give my child permission to be active as a participant.  I understand that my child will be asked to participate fully in all activities and will be expected to abide by all rules and policies.  I understand that The Awakening Arts is not responsible for lost, stolen or damage of personal property while my child is rehearsing or performing.     *
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