Julian Music and Performing Arts Camp

Parent or Legal Guardian Information
Parent/Legal Guardian
Relation
Phone Number

Area CodePhone Number
Second Phone

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Primary Phone 2

Area CodePhone Number
Second Phone 2

Area CodePhone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)
First and Last Name
Emergency Number

Area CodePhone Number
Email Confirmation
Parents Email
Health Information

A health officer is on site at all times.
Are vaccinations up to date?
List any allergies (ex: bees,peanuts, dairy)

Camper Photo Release
I agree that photos of my child(children) can be taken and used for camp social media purposes
- Be certain to enter your email address correctly on the registration form to receive confirmation.
Payment

$50 registration fee due today
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper(s), and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper(s) by authorized personnel. The camp carries secondary insurance. I understand that the above named camper(s) will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.
Electronic signature, please initials

Registration$50.00

Quantity

Total $0.00

Camper's Information