OCPA Spring Break Camp 2015 Registration Form

Full Student Name*

First NameLast Name

Age*

Date of Birth*

MonthDayYear

Gender*

MaleFemale

Choose Your Camp*

Spring Break Camp - Ages 6-12Spring Break Camp - Ages 13-19 - The Confident Audition

If you have additional students joining the camp, please list them here:

Full Student Name

First NameLast Name

Age

Date of Birth

MonthDayYear

Gender

MaleFemale

Choose Your Camp*

Spring Break Camp - Ages 6-12Spring Break Camp - Ages 13-19 - The Confident Audition

Full Student Name

First NameLast Name

Age

Date of Birth

MonthDayYear

Gender

MaleFemale

Choose Your Camp*

Spring Break Camp - Ages 6-12Spring Break Camp - Ages 13-19 - The Confident Audition

Full Student Name

First NameLast Name

Age

Date of Birth

MonthDayYear

Gender

MaleFemale

Choose Your Camp*

Spring Break Camp - Ages 6-12Spring Break Camp - Ages 13-19 - The Confident Audition

Parent/Guardian Name*

Email Address*

Home Phone Number*

Area CodePhone Number

Cell Phone Number

Area CodePhone Number

Work Phone Number

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact*

Emergency Contact's Phone Number*

Area CodePhone Number

Medical Issues or other special needs

CAMPS WILL BE HELD AT

FBC (First Baptist Church of Medford)

649 Crater Lake Ave.

MEDFORD, OR 97504

Payment due in full by first day of camp, unless otherwise arranged.

Please note that a $50 deposit (included in the total camp price) is non-refundable and holds the student’s place in the camp.

PAYMENT/CANCELLATION POLICY: You must notify OCPA, in writing, at least two weeks before the start of classes if you are withdrawing. You will receive a refund less the $50 deposit. If you do not formally withdraw, you are responsible for the full tuition. Our classes have a limited number of spaces available, and all must be filled to make our offerings possible.

DISCOUNTS POLICY: If registering for multiple camps or multiple students in one family, a 10% discount may be applied. If registering before March 2, 2019, you can use our "EARLYBIRD" coupon code to save $25 off tuition of one child, or use "EARLYBIRDS" coupon code to save $50 off tuition of two or more students.

REFUND POLICY: A full refund will be given if the camp is canceled by OCPA.

MEDICAL CONSENT AND RELEASE OF LIABILITY: I, the undersigned, do hereby authorize the directors and instructors of OCPA as agents to consent to medical treatment in an emergency. I hereby release and discharge OCPA from any and all claims for personal injury.

PERMISSION FOR PHOTO RELEASE: I agree that photographs of my student, taken during classes, may be used for promotional purposes by OCPA but will not be used by other organizations without addition written consent.

ATTENDANCE: Students learn by attending each day of camp. PLEASE register with a commitment to attend every day of camp. If schedule conflicts arise that are not noted on this form, please inform the instructor the first day of camp.

If you know now of any schedule conflicts during the session, please make a note of the dates here:

Conflicts:

Parent/Guardian Signature - click and drag to sign*

Date*

MonthDayYear

PAY FOR TUITION OR DEPOSIT ONLY

The Scholarship Application is available here. Please note that all Scholarship Applications must be accompanied by the $50 non-refundable deposit.

My Products*

Spring Break Camp - Ages 6-12$250.00

# of students

Spring Break Camp - Ages 13-19 - The Confident Audition$250.00

# of students

Deposit only, per student; the remaining $200 tuition is due in full due by first day of class$50.00

# of students enrolled

Enter coupon

Total $0.00

OREGON CONSERVATORY OF PERFORMING ARTS