Arlington Registration Form-Summer Camp 2019

Please fill out a separate form for each child.

1. General Information

* Indicates required field

Child's Name *

First

Last

Gender *

Child's Birthdate (mm/dd/yyyy) *

Parent/Guardian's Name *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Name of person picking child up from camp *

Relationship to the child *

Camp *

Dramatic Kids, June 24-28, Tuckahoe ES $325 Dramatic Kids, July 22-26, Tuckahoe ES $325 Theatrical Teens, July 22-26, Tuckahoe ES $325 Act It Out, Aug 12-16, Tuckahoe ES $325 Dramatic Kids, Aug 12-16, Tuckahoe ES $325 Theatrical Teens, Aug 12-16, Tuckahoe ES $325

2. Medical & Emergency Information

Allergies (if applicable) *

Primary Emergency Contact *

First

Last

Primary Emergency Contact Phone Number *

Secondary Emergency Contact *

First

Last

Secondary Emergency Contact Phone Number *

Please list any special assistance or accomodations needed *

3. Photo Release Agreement

I grant to CARE Actor, LLC the right to use photographs of my son/daughter and my family in connection with the above-identified event. I authorize CARE Actor, LLC to use these photographs in promotional materials i.e. brochures, website, marketing materials for such purposes as publicity, illustration, advertising, and web content.

Select One: *

4. Hold Harmless Agreement

As the legal parent or guardian, I release and hold harmless CARE Actor, LLC, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of CARE Actor, LLC its owners and operators or en route to or from any of said premises.

Hold Harmless Agreement *

I've read the above and agree.

Additional Comments *

Choose your camp package!

Arlington Parks & Rec.Summer Camps 2019Registration Form

1. General Information

2. Medical & Emergency Information

3. Photo Release Agreement

4. Hold Harmless Agreement

Arlington Parks & Rec.
Summer Camps 2019
Registration Form