Registration Form: Student Liability, Waiver and Media Release CNSIMP20241130

Spring Break CAMP 2025 @ RCS Elementary Campus

(5240 Woodwards Rd, Richmond) HELLOilluma@gmail.com 604.617.7138 （Text preferred | SMS短信、WhatsApp)
Information about 2025 Spring Break Camp is below. Please contact for translation.

Vous trouverez ci-dessous des informations sur le camp de relâche de printemps 2025. Veuillez contacter pour la traduction HELLOilluma@gmail.com.

以下是有關您孩子2025春假夏令營的重要訊息 – 如需要中文翻譯的協助，歡迎電郵致 HELLOilluma@gmail.com。

以下是有关您孩子2025春假夏令营的重要信息 – 如需要中文翻译的协助，欢迎电邮至 HELLOilluma@gmail.com。

Sing & Dance Sampler: Jazz Funk. Hip Hop. KPOP. Stretch & Strength. Play.
- WEEK 1: March 17-21, 2025
- WEEK 2: March 24-28, 2025
Families can choose from these options for Week 1 and/or Week 2:

Curriculum will be different between same-subject sessions; we welcome repeat campers!
1. Half day camp (AM or PM Camp)
2. AM Camp with before camp care
3. PM Camp with after camp care
4. Full Day Camp = AM Camp + PM Camp (with before / after camp care options)
PAYMENT

You will be contacted for payment after submitting the registration. There are two (2) payment options:

- E-transfer: HELLOilluma@gmail.com

- Credit Card payments are subject to a $10 administration fee
Camp Description and Details

Come learn a variety of dancing and aspects of musical theatre including some singing and acting through FUN games! Students will be introduced to Jazz Funk, Street and Korean Pop (KPOP) dance styles through cardio warm ups, strengthening, footwork, isolations, stretches and learn the importance of breathing. There will be purposeful indoor games and outdoor playtime (as weather permits). Learn teamwork while supporting classmates, have fun, and rise to a new challenge! No previous experience required; content is accessible and adapted to the learner's level. Showcase for full-day campers will occur at the end of their afternoon session (or recorded with permisson).

Dress: dry indoor shoes with non-marking soles preferred (especially during rain/snow season), comfortable sports, loose, & baggy clothing. Bring your water bottle and sufficient nut free snacks and lunch to fuel your child for an energetic workout! Curriculum will be different between same-subject sessions; we welcome repeat campers!

Find us on FB/IG @illumastudio. Bring Your Shine!
Registration: Student Liability, Waiver and Media Release Form
报名表格：免除责任声明/ 免责申索和赔偿/ 宣传之授权及发布表
Student 1: Name 学生一: 姓名*

First Name 名字Last Name 姓氏
Student 1 Birthdate 出生日期*

MonthDayYear
MM-DD-YYYY 月月-日日-年年年年
2025 Spring Break Camp 春假课程 WEEK 1: March 17-21 WEEK 2: March 24-28

***WEEK 1: March 17-21 - Age 5-7*** (CHOOSE BELOW)Wk 1 - AM Camp: age 5-7 WITH BEFORE CAREWk 1 - AM Camp: age 5-7Wk 1 - PM Camp: age 5-7Wk 1 - PM Camp: age 5-7 WITH AFTER CARE***WEEK 1: March 17-21 - Age 8-14*** (CHOOSE BELOW)Wk 1 - AM Camp: age 8-14 WITH BEFORE CAREWk 1 - AM Camp: age 8-14Wk 1 - PM Camp: age 8-14Wk 1 - PM Camp: age 8-14 WITH AFTER CARE***WEEK 2: March 24-28 - Age 5-7*** (CHOOSE BELOW)Wk 2 - AM Camp: age 5-7 WITH BEFORE CAREWk 2 - AM Camp: age 5-7Wk 2 - PM Camp: age 5-7Wk 2 - PM Camp: age 5-7 WITH AFTER CARE***WEEK 2: March 24-28 - Age 8-14*** (CHOOSE BELOW)Wk 2 - AM Camp: age 8-14 WITH BEFORE CAREWk 2 - AM Camp: age 8-14Wk 2 - PM Camp: age 8-14Wk 2 - PM Camp: age 8-14 WITH AFTER CARE
Student 2: Name 学生二: 姓名

First Name 名字Last Name 姓氏
Student 2 Birthdate 出生日期

MonthDayYear
MM-DD-YYYY 月月-日日-年年年年
2025 Spring Break Camp 春假课程 WEEK 1: March 17-21 WEEK 2: March 24-28

***WEEK 1: March 17-21 - Age 5-7*** (CHOOSE BELOW)Wk 1 - AM Camp: age 5-7 WITH BEFORE CAREWk 1 - AM Camp: age 5-7Wk 1 - PM Camp: age 5-7Wk 1 - PM Camp: age 5-7 WITH AFTER CARE***WEEK 1: March 17-21 - Age 8-14*** (CHOOSE BELOW)Wk 1 - AM Camp: age 8-14 WITH BEFORE CAREWk 1 - AM Camp: age 8-14Wk 1 - PM Camp: age 8-14Wk 1 - PM Camp: age 8-14 WITH AFTER CARE***WEEK 2: March 24-28 - Age 5-7*** (CHOOSE BELOW)Wk 2 - AM Camp: age 5-7 WITH BEFORE CAREWk 2 - AM Camp: age 5-7Wk 2 - PM Camp: age 5-7Wk 2 - PM Camp: age 5-7 WITH AFTER CARE***WEEK 2: March 24-28 - Age 8-14*** (CHOOSE BELOW)Wk 2 - AM Camp: age 8-14 WITH BEFORE CAREWk 2 - AM Camp: age 8-14Wk 2 - PM Camp: age 8-14Wk 2 - PM Camp: age 8-14 WITH AFTER CARE
Student 3: Name 学生三: 姓名

First Name 名字Last Name 姓氏
Student 3 Birthdate 出生日期

MonthDayYear
MM-DD-YYYY 月月-日日-年年年年
2025 Spring Break Camp 春假课程 WEEK 1: March 17-21 WEEK 2: March 24-28

***WEEK 1: March 17-21 - Age 5-7*** (CHOOSE BELOW)Wk 1 - AM Camp: age 5-7 WITH BEFORE CAREWk 1 - AM Camp: age 5-7Wk 1 - PM Camp: age 5-7Wk 1 - PM Camp: age 5-7 WITH AFTER CARE***WEEK 1: March 17-21 - Age 8-14*** (CHOOSE BELOW)Wk 1 - AM Camp: age 8-14 WITH BEFORE CAREWk 1 - AM Camp: age 8-14Wk 1 - PM Camp: age 8-14Wk 1 - PM Camp: age 8-14 WITH AFTER CARE***WEEK 2: March 24-28 - Age 5-7*** (CHOOSE BELOW)Wk 2 - AM Camp: age 5-7 WITH BEFORE CAREWk 2 - AM Camp: age 5-7Wk 2 - PM Camp: age 5-7Wk 2 - PM Camp: age 5-7 WITH AFTER CARE***WEEK 2: March 24-28 - Age 8-14*** (CHOOSE BELOW)Wk 2 - AM Camp: age 8-14 WITH BEFORE CAREWk 2 - AM Camp: age 8-14Wk 2 - PM Camp: age 8-14Wk 2 - PM Camp: age 8-14 WITH AFTER CARE
Note: if you have more than 3 kids enrolling, please refresh this form after your initial submisson and register for your additional children.

Remarque : si vous avez plus de 3 enfants inscrits, veuillez actualiser ce formulaire après votre soumission initiale et inscrire vos enfants supplémentaires.

注意：如果您报名的孩子超过 3 个，请在首次提交后刷新此表格并为您其他的孩子注册。
Name of Emergency Contact 1, and relationship to student 紧急联系人1姓名与学生关系*
E.g. Eve Jones. Mother; Adam Smith. Father; Betty Cook, Guardian 例：Sara Li, 妈妈mother; Peter Chen, 爸爸father; Mary Zhang, 祖母grandmother
Emergency Contact 1 Phone Number 紧急联系人1电话*
Please enter a valid phone number.
Emergency Contact 1 Email Address紧急联系人1电邮*
example@example.com
Name of Emergency Contact 2, and relationship to student 紧急联系人2姓名与学生关系*
E.g. Eve Jones. Mother; Adam Smith. Father; Betty Cook, Guardian
Emergency Contact 2 Phone Number 紧急联系人2电话*
Please enter a valid phone number.
Emergency Contact 2 Email Address 紧急联系人2电邮
example@example.com
Address 住址

Street Address 街道号码、街名、公寓号码

Street Address Line 2 街道号码、街名、公寓号码

City 城市State / Province 州 / 省份

Postal / Zip Code 邮政编码
Name of Current School(s) 就读学校

Richmond Christian ECRichmond Christian MCRichmond Christian SCOther
ALL CAMPERS: Please state name of the friend your child(ren) would like to be grouped with. If you attend a school other than RCS, please state the name of your school. 请注明您的小孩希望与哪个小朋友分组。如果您就读于 RCS 以外的学校，请注明您的学校名称。
Please put all schools that apply 请列出所有学校
Do you have any allergies, medical conditions or existing injuries / physical conditions? 是否对食物或药物有过敏反应？是否有过任何受伤史？*

Yes 有No 否
If you chose "yes" to the previous question, please tell us more 如有，请列出对食物或药物过敏的反应和任何受伤史:
E.g. allergies, medical conditions or existing injuries / physical conditions
Student's Personal Health Number (PHN) 医疗卡号:
If more than 1 child: 1) Student 1's PHN 2) Student 2's PHN 3) Student 3's PHN
Does this student have any learning preferences / needs based on any neural divergent / spectrum situations? We strive to customize your student's experience and aim to fine-tune our program to meet your child's needs. Please let us know how we can help! :) 请问学生是否有任何特殊生理或心理状况或学习偏好/需求？我们将尽力提供良好的学习经验并致力调整我们的课程以满足您孩子的需求。请告诉我们如何辅助您的孩子! :)
What are your expectations of this camp? e.g. learning outcomes. Do you have any other feedback for us? 请问您对这个训练营有什么期望？例：学习成果。请问您还有其他意见或回应吗？
Child Sign Out By: Self Release? 请问上课后学生可以善治离开课室吗？*

Yes, self release. 可以自己离开课室。No, pick up only. 不可以离开，需要等待家人、监护人接管。
If child is to be signed out by pick up only, what is the FULL NAME of the pick up person? (Please provide identification documents at pick up.) 如果学生需要等待家人、监护人接管请填上接管人姓名。（您可以列出多个人。接学生时请显示身份证明。）
TYPE name of the parent or guardian and state relationship with child. E.g. Bugs Bunny - grandfather 请在下面的空格子里填家长或监护人的姓名并且声明与学生的关系。例：John Wang - 外公grandfather
How did you know about our program (please pick all options)?请问您是如何得知我们的课程？*

RCS Direct Email Message 学校电邮通信RCS Newsletter 学校通讯PRINTED poster 海报Past student 旧生Friend referral 朋友介绍Facebook / Instagram 脸书WeChat / Xiaohongshu 微信、小红书Other 其他
Please provide the name of your friend that referred. 请说明推荐朋友的大名。
**LIABILITY RELEASE** While I am a student of ILLUMA Studio’s classes, I hereby agree to hold blameless ILLUMA Studio and its teachers, administrators, staff, and/or volunteers from and against allocations claims, demands, damages or loss of whatever nature which may be sustained while in any activity associated with the school, as well as of any medical treatment authorized by the supervising individuals representing ILLUMA Studio. While our teachers maintain a professional teaching standard, we cannot prevent accidents and injuries during classes. ILLUMA Studio is not responsible for injuries as well as any related dispute and claim for compensation. All payments non-transferable and non-refundable. 當我在ILLUMA Studio學習期間，我願意解除對ILLUMA Studio學校及教師、管理人員、員工、和義工因在學校中導致我本人或財產上任何損失的索賠；除非校方同意，本校不设退还或转让学费。所有在校任职的舞蹈老师将会对学员提供全面而专业的教学指导，但也不能确保在训练过程中没有意外发生。如学生在校内训练期间意外受伤，学校将不承担任何法律责任，连带纠纷及经济索赔等。所有风险责任将根据商业保险公司条例处理。*

I agree 我同意
**INFORMATION and MEDIA RELEASE** As the student, parent or guardian of the listed student(s) above, I grant permission to ILLUMA Studio and their representative the usage of my photos and/or filming for internal programming evaluation, advertising, promotional, and publicity purposes on any platform. I also grant permission for ILLUMA Studio to use my contact for present and future matters. 作为上列学生的家长或监护人, 我完全授权并允许ILLUMA Studio及其授权代表出于上述目的或与之相关的目的根据需要列印、拍照、记录及编辑上列学生在音频、视频、影片、幻灯片或当前制作的任何其他电子和印刷形式的传记讯息、姓名、图像、肖像及/或声音的权利。我还授权ILLUMA Studio使用我的联系质料沟通当前和未来的事务。*

I agree 我同意I agree for internal programming evaluation purposes only 我同意只用于内部沟通和教师或教材评估。
** AGREEMENT ** I understand and acknowledge that when I or my child participates in ILLUMA Studio's programs, I am / they are under supervision only during the applicable time periods stated in my activity registration receipt. I HAVE READ, UNDERSTOOD AND AGREE WITH ALL THE ABOVE AND SIGN IT TO COVER ALL OF ILLUMA Studio's ACTIVITIES. Typing in the name of the student, parent or guardian (if student is under 19) in the field below constitutes agreement that the student is physically able to take this course, and parent or guardian assumes responsibility and liability that may arise during the course of performing arts or exercise at ILLUMA Studio's program. Student, parent or guardian further waives any and all claims against ILLUMA Studio. 我理解并承认，当我或我的孩子参加ILLUMA Studio 的课程时，我/他们只限于课堂的时间段内受到监督(课堂细明在社区中心活动登记收据中)。我已阅读、理解并同意上述所有内容，并签署以涵盖 ILLUMA Studio 的所有活动。在下面输入学生、家长或监护人的姓名(如果学生未满 19 岁)即表示同意该学生的身体状况能够参加本课程。家长或监护人承担在课程和学习期间可能出现的风险和责任并且放弃对ILLUMA Studio的任何申索和赔偿。请在下面的空格子里填上学生、家长或监护人的姓名(如果学生未满 19 岁)并且声明与学生的关系。例：John Wang - 外公grandfather*
TYPE name of the student, parent or guardian (if student is under 19) and state relationship with child. E.g. Bugs Bunny - grandfather
THANK YOU FOR ENTRUSTING US WITH YOU CHILD AND BELIEVING IN PERFORMING ARTS; it is a crucial part of child development!
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Spring Break CAMP 2025 @ RCS Elementary Campus

THANK YOU FOR ENTRUSTING US WITH YOU CHILD AND BELIEVING IN PERFORMING ARTS; it is a crucial part of child development!