TO REGISTER FOR SUMMER CAMP:

Please Fill out this form in its entirety! Your child is not registered until

Liability Waiver and Code of Conduct Forms are signed!

Student First name

Student Last Name

Student Date of birth

Month

Day

Year

Please List All Camps you would like to register this student for, including grade level if applicable (if a camp is offered for two different grade levels!)

Parent/Guardian First and Last

Parent/Guardian Email

Parent/Guardian Phone #

Multi-line address

Country/Region

Address

City

Zip / Postal code

If you would like to register (a) sibling(s), please put their First and Last Name, Age and ALL camps registering for in this spot.

I declare that I have read and acknowledge the IMAGINE PERFORMING ARTS CENTER PARTICIPATION, AGREEMENT, LIABILITY WAIVER, AND POLICY ACKNOWLEDGEMENT,

https://www.imagineperformingartscenter.org/liabilitywaiver

By signing, I acknowledge that I have read, understood, and agree to all the terms and conditions stated in this agreement.

Signature field is empty.

I declare that I have read and acknowledge the IMAGINE PERFORMING ARTS CENTER STUDENT CODE OF CONDUCT

https://www.imagineperformingartscenter.org/codeofconduct

By signing, I confirm that I have read, understood, and agree to the student code of conduct, and I am aware of the consequences of not adhering to it.

Signature field is empty.

Emergency Contact Name

Emergency Contact Phone