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STUDENT REGISTRATION
Montgomery County Summer Camps 2019
1. General Information
(Please fill out a separate form for each child.)
*
Indicates required field
Child's Name
*
First
Last
Gender
*
Male
Female
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
*
Camp
*
Dramatic Kids! Jul 8 - 12, 2019, Cashell ES, $325
Act It Out! Jul 8 - 12, 2019, Cashell ES, $325
Dramatic Kids! Jul 15 - 19, 2019, Hallie Wells MS, $325
Act It Out! Jul 15 - 19, 2019, Hallie Wells MS, $325
Dramatic Kids! Aug 5 - 9, 2019, Jane E. Lawton Rec. Ctr., $325
Act It Out! Aug 5 - 9, 2019, Jane E. Lawton Rec. Ctr., $325
Name of person picking child up from camp
*
Relationship to the child
*
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:
*
Yes
No
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!
Home
About Us
Our Story
Meet the Staff
Join Our Team
SUMMER CAMPS
Teen Performance Camps
Teacher Resources
Blog