2014 summer camp application form waiver and · pdf file2014 summer camp application form...

2014 Summer Camp Application Form Waiver and Release Participant’s 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 Yip’s Music & Mon- tessori Elementary Private School, of whom I am the legal guardian, and the permission to participate in the outdoor programs organized by Yip’s Music & Montessori Elementary Private School. I hereby waive and forever discharge the Yip’s 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 Yip’s 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: TOTAL Cheque # ________ 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 Nap Music Camp - Piano / Violin P.M. Session - Cantonese / Mandarin

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2014 Summer Camp Application Form Waiver and Release

Participant’s 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 Yip’s Music & Mon-tessori Elementary Private School, of whom I am the legal guardian, and the permission to participate in the outdoor programs organized by Yip’s Music & Montessori Elementary Private School. I hereby waive and forever discharge the Yip’s 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 Yip’s 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: _______________________________________________