North Shore Summer Camp Registration Form

Camper's Name

First NameLast Name

Are you a returning Camper or an Ava Music Student

YesNo

Birth Date*

MonthDayYear

Grade*

Gender*

MaleFemaleOther

Parent/Guardian Information

Name

First NameLast Name

Cell Number*

E-mail*

example@example.com

Your Address*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Does the Camper have any allergies, chronic illness, or medical conditions? Is the Camper prescribed an inhaler? If yes, please describe.*

Choose a week that your child will attend the Summer Camp*

Choose one of the Camp *

Camper's age group*

(Morning Camp Ages 3 to 6) Select one Class Per hour*

Orff & Kodaly Classes (9:15 to 10:15)Piano/Art (10:30 am to 11:30 am)Violin/Art (10:30 am to 11:30 am)

(Morning Camp Ages 7 to 12) Select one Class Per hour*

Piano/Art (9:15 am to 10:15 am)Drum/Art (9:15 am to 10:15 am)Violin/Art (9:15 am to 10:15 am)Guitar (10:30 am to 11:30 am)

(Morning Camp Ages 13 to 18) Select This Class*

Musical Theatre/Dance (9:15 am to 11:30 am)

(Afternoon Camp Ages 3 to 6) Select This Class*

Musical Theatre/Dance (1:00 pm to 3:15 pm)

(Afternoon Camp Ages 7 to 12) Select One Of These Activities*

Acting/Film(1:00 pm to 3:15 pm)Musical Theatre/Dance (1:00 pm to 3:15 pm)

(Afternoon Camp Ages 13 to 18) Select This Class*

Acting/Film (1:00 pm to 3:15 pm)

(Full-Day Camp Ages 3 to 6) Select One Activity Per Hour*

Orff & Kodaly Classes (9:15 to 10:15)Piano/Art (10:30 am to 11:30 am)Violin/Art (10:30 am to 11:30 am)Musical Theatre/Dance (1:00 pm to 3:15 pm)

(Full-Day Camp Ages 13 to 18) Select Both Activities*

Musical Theatre/Dance (9:15 am to 11:30 am)Acting/Film (1:00 pm to 3:15 pm)

(Full-Day Camp ages 7 to 12) Select One Activity Per Hour*

Piano/Art (9:15 am to 10:15 am)Drum/Art (9:15 am to 10:15 am)Violin/Art (9:15 am to 10:15 am)Guitar (10:30 am to 11:30 am)Acting/Film(1:00 pm to 3:15 pm)Musical Theatre/Dance (1:00 pm to 3:15 pm)

Informed Consent, Medical Authorization, and Media Release

By registering for North Shore Summer Camp hosted by Ava Music & Art Centre Ltd., I, the undersigned parent or legal guardian, hereby acknowledge and agree to the following terms and conditions on behalf of the registered minor child (“the Participant”):

1. Informed Consent and Acknowledgment of Risk
I hereby consent to the participation of the Participant in all activities organized and conducted by Ava Music & Art Centre Ltd. as part of North Shore Summer Camp, including but not limited to music, dance, acting, visual arts, and film-based activities (collectively, “the Activities”).

I understand and acknowledge that participation in the Activities involves inherent risks, including but not limited to minor injuries, fractures, sprains, allergic reactions, and in rare cases, more serious injuries such as paralysis or death. I voluntarily assume all such risks, known and unknown, on behalf of the Participant.

I further agree to release, waive, indemnify, and hold harmless Ava Music & Art Centre Ltd., its directors, officers, employees, instructors, contractors, agents, volunteers, and affiliates (collectively, “the Releasees”) from any and all liability, claims, demands, causes of action, or damages arising from or related to the Participant’s involvement in North Shore Summer Camp, including transportation to and from the premises.

2. Medical Release and Emergency Authorization
In the event of a medical emergency involving the Participant, I hereby authorize any qualified and licensed medical professional to provide any necessary medical treatment, including but not limited to diagnosis, x-rays, surgery, hospitalization, or other procedures deemed medically necessary to preserve the health and well-being of the Participant.

This authorization is granted only after reasonable attempts have been made to contact me or the emergency contact listed on the registration form. I further grant permission to Ava Music & Art Centre Ltd. staff to administer basic first aid and seek emergency medical care for the Participant until professional medical assistance is available.

I agree to be financially responsible for any costs incurred as a result of medical treatment provided under this authorization.

3. Media Release: Photography, Video, and Audio Recording Consent
I hereby grant full permission to Ava Music & Art Centre Ltd. and North Shore Summer Camp to photograph, videotape, film, or audio record the Participant during camp activities. I understand and agree that these recordings may be used by Ava Music & Art Centre Ltd. for promotional, educational, or informational purposes, including but not limited to social media, printed publications, newsletters, websites, advertisements, and other marketing materials, without compensation or further notice.

I waive any right to inspect or approve the finished media product and release Ava Music & Art Centre Ltd., North Shore Summer Camp, and their representatives from any and all claims, demands, or causes of action which may arise out of the use of such recordings, including without limitation claims for libel or invasion of privacy.

If I do not wish to grant this media consent, I understand it is my responsibility to notify Ava Music & Art Centre Ltd. in writing prior to the start of camp.

4. Electronic Signature and Binding Agreement
By acknowledging and signing below, I confirm that I have read, understood, and voluntarily agree to the terms of this Informed Consent, Medical Authorization, and Media Release form. I acknowledge that my electronic signature shall have the same legal force and effect as a manual signature and shall be equally binding.

Date

Signature

Summer Camp Registration

Camper Information