Camp Art | Beyond the Stage LLC

Child Name

Child Age

Child School

Parent Name

Home Schooled

Phone Number

E-Mail Address

Home Address

Which camp are you signing up for? Required

Summer Session 1

Summer Session 2

Summer (Both Sessions)

Spring Break

My child will attend....

Full Camp

Drop-In

Does your camper have any exceptionalities or special needs we should be aware of? (e.g., learning, behavioral, medical, physical, etc.) Required

Yes

If yes, please provide details below to help us better support your camper:

Does your child have any food allergies? Required

Yes

Please list any dietary restrictions/alergies. Enter "N/A" if there aren't any.

Are you interested in child care? Required

Morning

Afternoon

Both

No, not interested in child care

Liability Waiver

Liability Release and Parental Consent Form in consideration of the acceptance of my application for the above program, I am giving up my rights, the rights of my spouse and or child(ren) to sue Beyond The Stage LLC for any and all claims in damages for personal injury, property damage or which may hereafter occur as a result of participation in said event. This agreement is intended to discharge in advance Beyond The Stage LLC and the premises Holy Faith Temple Baptist Church, its employees, agents, camp staff, and volunteers from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some recreational activities and unforeseen events involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assignees. Required

I agree

Media Release waiver

I, the undersigned, herby authorize Beyond The Stage LLC to photograph me, take motion pictures of me, take video footage of me, and/or make electronic sound recordings of me (herein referred to as photographic or electronic reproductions). I authorize the use of any such photographic or electronic reproductions of me for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by Beyond The Stage LLC (I understand that I may be identifiable from such photographic or electronic reproduction). Required

I agree

Your Signature

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BEYOND THE STAGE LLC