Math & Music Makers After School Student Information Form- Covered Bridge
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How did you hear about Math & Music Makers?
Child's First Name *
Child's Last Name *
Child's Age *
Date of Birth *
Parent(s) Name(s) *
Home Address and Mailing Address if different *
Home Phone *
Cell Phone *
Work Phone *
email address *
Emergency Contact and phone number *
Person(s) allowed to pick up student *
Your child's grade and teacher's name *
Session attending *
Check the box(es) of which Math & Music camp session your child will attend
Required
Does your child have any medical or physical conditions, allergies, or anything that we need to be aware of or that may hinder him/her from fully participating in any camp activities. *
Please explain in detail below.
Do you have any specific Math or Music needs for your child? *
Please explain in detail below.
Initial here to acknowledge that Math & Music Makers is not responsible for any medical, hospital or pharmaceutical bills originating while the student participates in the program.   *
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