SFAC VACATION CAMP 2015 Creative Arts Centre, 97c Circular Road, San Fernando.

[Ages 7-13years] [Monday 13th Friday 14th August 2015] [8am-3pm]

REGISTRATION FORM

NAME (BLOCK LETTERS) ______________________________________________________________AGE ______________

DATE OF BIRTH ______________________TELELPHONE _________________________MOBILE _____________________

ADDRESS _______________________________________________________________________________________________

_________________________________________________EMAIL _________________________________________________

PARENT / GUARDIAN ____________________________________________________________________________________

TELEPHONE/ MOBILE ____________________________________________________________________________________

ADDRESS _______________________________________________________________________________________________

________________________________________________________________________________________________________

SCHOOL ATTENDING ____________________________________________________________________________________

ALLERGIES______________________________________________________________________________________________

FOOD ALLERGIES________________________________________________________________________________________

MEDICATION BEING TAKEN______________________________________________________________________________

MEDICAL SPECIAL NEEDS________________________________________________________________________________

IN CASE OF EMERGENCY, PLEASE CALL __________________________________________________________________

PHONE________________________________________________RELATION _______________________________________

ADDRESS ______________________________________________________________________________________________

________________________________________________________________________________________________________

CAMPER AGREEMENT- I affirm that my participation in the Vacation Camp is entirely voluntary. I understand that if I have questions about possible hazards, it is my responsibility to seek additional information from the Vacation Camp staff prior to signing this Form. I understand that the best way to make sure that I remain safe and avoid injury is to follow the rules, regulations and instructions of the staff of the Camp. I agree that I will learn and obey all the rules and regulations and will follow all instructions of the staff of the Camp. PARENT/GUARDIAN AGREEMENT I agree to allow my child/ward to participate in the Vacation Camp and affirm that my childs/wards participation is completely voluntary. I have instructed my child/ward to obey all the rules, regulations and instructions of the Vacation Camp. PHOTO RELEASE: I give permission for photographs taken of me/my child/ward while participating in the Camp to be used in marketing/public relations material in the promotion of Vacation Camp. By signing below, I acknowledge that I have read, understand and agree to the terms outlined above: Parent/Guardian Name ________________________Signature __________________________ Date_______________

OFFICIAL USE ONLY

REMARKS ________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

PAID _________________________________ DATE _________________________________ RECEIPT #___________________

AUTHORIZED SIGNATURE ___________________________________DATE__________________________________________