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

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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<ul><li><p>2014 Summer Camp Application Form Waiver and Release</p><p>Participants Name: ______________________________________</p><p>Parent/Guardian Name: __________________________________</p><p>Tel #: ______________________ Cell #: _____________________</p><p>Email Address: _________________________________________</p><p>Emergency Contact: _____________________________________</p><p>Tel #: ______________________</p><p>Event: Sport &amp; Outdoor Activities &amp; Field Trip</p><p>In consideration of the acceptance of the above entry in Yips Music &amp; 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 &amp; Montessori Elementary Private School. I hereby waive and forever discharge the Yips Music &amp; 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 &amp; outdoor activities &amp; field trips). I acknowledge and agree that the Yips Music &amp; Montessori Elementary Private School may use photographs of the participants therein for promotional purposes.</p><p>_____________________________Parent/Guardian Signature</p><p>____________________________________Date</p><p>____________________________________ Witness</p><p>Address: _______________________________________________</p><p> _______________________________________________</p><p>Home #: </p><p>Term Date Camp FD / HD Fee</p><p>Extended Hours ($5 / session):7:00 - 9:00 a.m. &amp;/or 4:00 - 6:30 p.m.</p><p>Lunch Fee ( $5 / meal ):</p><p>Material Fee ( $5 / week - HD, $8 / week - FD ):</p><p>Payment Method: TOTALCheque # ________ or Cash Date: ___________________ ( mm/dd/yyyy )</p><p>Allergy: _______________________________________________</p><p>Name: (Eng) _____________________________</p><p> (Chi) _____________________________</p><p> Sex: (F/M) _____ Age: _____ DOB: _________________ mm / dd / yyyy</p><p>For Officer Use Only:</p><p>Preschool Camp - Piano or Violin (over 3.9 yrs old) / Percussion - Nap / No NapMusic Camp - Piano / ViolinP.M. Session - Cantonese / Mandarin</p></li></ul>

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