REGISTRATION FORM

SFAC VACATION CAMP 2015

Creative Arts Centre, 97c Circular Road, San Fernando.

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

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__________________________________________