2014 summer camp application form waiver and summer camp application form waiver and release ......

Download 2014 Summer Camp Application Form Waiver and Summer Camp Application Form Waiver and Release ... sports outdoor activities field trips). ... Preschool Camp - Piano or Violin

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  • 2014 Summer Camp Application Form Waiver and Release

    Participants Name: ______________________________________

    Parent/Guardian Name: __________________________________

    Tel #: ______________________ Cell #: _____________________

    Email Address: _________________________________________

    Emergency Contact: _____________________________________

    Tel #: ______________________

    Event: Sport & Outdoor Activities & Field Trip

    In consideration of the acceptance of the above entry in Yips Music & Mon-tessori Elementary Private School, of whom I am the legal guardian, and the permission to participate in the outdoor programs organized by Yips Music & Montessori Elementary Private School. I hereby waive and forever discharge the Yips Music & Montessori Elementary Private School, the sponsors, representatives, their agents, officers, employees and any other person or organization assisting in the event from all claims, damages, costs and expenses in respect to damages or injury suffered by my/their person or property, however caused, which may occur as a result of my/their participa-tion in the program in any location where the program is being held (i.e. sports & outdoor activities & field trips). I acknowledge and agree that the Yips Music & Montessori Elementary Private School may use photographs of the participants therein for promotional purposes.

    _____________________________Parent/Guardian Signature

    ____________________________________Date

    ____________________________________ Witness

    Address: _______________________________________________

    _______________________________________________

    Home #:

    Term Date Camp FD / HD Fee

    Extended Hours ($5 / session):7:00 - 9:00 a.m. &/or 4:00 - 6:30 p.m.

    Lunch Fee ( $5 / meal ):

    Material Fee ( $5 / week - HD, $8 / week - FD ):

    Payment Method: TOTALCheque # ________ or Cash Date: ___________________ ( mm/dd/yyyy )

    Allergy: _______________________________________________

    Name: (Eng) _____________________________

    (Chi) _____________________________

    Sex: (F/M) _____ Age: _____ DOB: _________________ mm / dd / yyyy

    For Officer Use Only:

    Preschool Camp - Piano or Violin (over 3.9 yrs old) / Percussion - Nap / No NapMusic Camp - Piano / ViolinP.M. Session - Cantonese / Mandarin

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