Julian Music and Performing Arts Camp

Julian Music and Performing Arts Camp
Camper's Information
Last Name*
Middle Name
First Name*
Gender*

MaleFemale
Address*
City*
State*
Zip*
Birth Date*

MonthDayYear
Grade entering in the fall*
Select Camp Week(s)

Wk 1: June 30 - July 3Wk 2: July 7 - July 11Wk 3: July 14 - July 18Wk 4: July 21 - July 25 Faith Church VBS (FREE)Wk 5: July 28 - Aug 1Wk 6: Aug 4 - Aug 8Wk 7: Aug 11 - Aug 15Wk 8: Aug 18 - Aug 22Wk 9: Aug 15 - Aug 29 (TBD Based on interest)
Register a 2nd child

Yes

End
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?*

YesNo
List any allergies (ex: bees,peanuts, dairy)

End
Camper Photo Release
I agree that photos of my child(children) can be taken and used for camp social media purposes*

YesNo
- 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*

My Products

Registration$50.00

Quantity

Total $0.00

Camper's Information