Potomac Falls Summer Drama Camp Registration 2021

Potomac Falls Summer Drama Camp Registration June/July, 2021

Permission, Authorization, & Acknowledgement of Risks
Please complete the following Registration, Acknowledgements, and Waivers Form. Once completed, you will need to return to the Summer Camp page on our website and complete the COVID-19 Assumption of Risk & Liability Waiver and submit payment. All three items need to be completed to secure your child's spot in our summer camp.
Child's Name *

First Name Last Name
Select the Camp *

June 21-25, 2021 - The Jungle Book Kids (Ages 8-12)
Student's Grade (for the upcoming school year) *
Parent/Guardian Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Emergency Contact *

First Name Last Name
Emergency Email *
example@example.com
Emergency Phone Number *

Area Code Phone Number
In the event of an emergency, is there anything a paramedic would need to know (i.e. Type I Diabetes, life-threatening allergies, etc.):
Student's T-Shirt Size (shirts will be pre-ordered, we will do our best to accommodate size requests) *

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Waivers & Acknowledgements
I understand that my child's participation in Potomac Falls Summer Drama Camp (Camp) is voluntary, that it is not required, and that there will be exposure to activities involving risks of serious injuries. I have read and understand the description of the Camp and give permission for my child's participation. *

I agree
I understand that Potomac Falls Drama Boosters (PFDB) will not be responsible for any personal property that may become lost or damaged during this Camp and that PFDB does not provide medical or accident insurance for student injuries involved with this Camp. I authorize and give permission for my child to receive first aid, emergency medical care and transport, medical treatment, and all other care deemed reasonably necessary for my child's health and well-being in case of an accident, injury, or serious illness during the Camp. I understand that I will be responsible on a primary basis for any related medical bills incurred. *

I agree
I understand that all school rules and regulations apply during this Camp, and further understand that parents/guardians are responsible for transportation to and from the camp. *

I agree
I certify that my child's registration is complete and understand that failure to submit any of the item on the Checklist will forfeit my child's participation in the Potomac Falls Summer Drama Camp. I also agree I will provide transportation and daily lunch for my child. *

I agree
Signature *

Clear
Name *

First Name Last Name
Date *

Month Day Year
Date

Check List & Payment Acknowledgement
Payment Method *

Online (from our Summer Camp webpage) Check (made payable to Potomac Falls Drama Boosters. Sent to Potomac Falls Drama Boosters, c/o Potomac Falls High School, 46400 Algonkian Pkwy, Potomac Falls, VA 20165)
Check List: Have you completed the following?

Registration: Permission, Authorization, and Acknowledgement of Risks COVID-19 Assumption of Risk and Liability Waiver Payment
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Potomac Falls Summer Drama Camp Registration June/July, 2021

Waivers & Acknowledgements

Check List & Payment Acknowledgement