October 27th & November 2nd

Game Day Camp Registration *

TSMS CG or WG Members

Have you attended our Dance Camp and/or Guard Camp in the past? *

Campers First Name *

Campers Last Name *

Sex *

Female

Male

BirthDate *

Age on October 27th *

T-Shirt Size *

School Currently Attending: *

Referral:

I am aware that camp is: Saturday, October 27th 9am-1pm and the performance is Friday, November 2nd at 5-9pm at Tarpon Springs HIGH School *

Yes

Well NOW I am aware :)

Camp Payment Due

Current Total:

$0.00

Parent/Guardian Contact Info

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Home Phone Number *

Email Address *

Additional Email Address

Please email me updates during camp

Mom's First Name *

Mom's Cell Phone *

Mom's Work Phone

Dad's First Name *

Dad's Cell Phone

Dad's Work Phone

Emergency Contact Info

Emergency Contact #1 if Parent's Can NOT be reached: *

Relationship *

Phone Number *

Alternate Phone Number

Emergency Contact #2 if #1 can NOT be reached: *

Relationship *

Phone Number *

Alternate Phone Number

List ONLY the authorized people to pick up and drop off your child during (separate by line and please re-list anyone entered above, including parents): *

My son/daughter has permission to walk or bike themselves home (Saturday only): *

No

Yes

Medical Info

My child has no known allergies

TRUE

My child has allergies to the following foods:

This causes anaphylaxis

Y

N

Describe reaction if food is eaten and what is done to manage it:

My child has allergies to the following drugs:

This causes anaphylaxis

Y

N

Please provide supportive health information about any chronic health condition, your concerns, and what we can/show should do:

My child is on the following medication(s):

The Conservatory fo the Arts DANCE CAMP (GAME DAY) staff will NOT administer medication, except in an emergency situation and/or we have explicit permission from parents.

What else would you like us to know about your child's health/beahvior and well-being?

LEGAL

I understand that the Conservatory for the Arts DANCE CAMP does not provide insurance. I also understand that children with reoccuring behavioral problems will be dismissed from camp without a refund. Misconduct will not be tolerated.

GAME DAY- All fees are non-refundable. Please sign below to verify your knowledge of the refund policy and that all of your information as well as your child's concerning their information, emergency contacts and medical history are correct and to the best of your knowledge.

Parent Initials acknowledging the above two (2) statements *

I, on behalf of myself, and the below named child (“Participant”) (collectively, the “Consentee”) acknowledge that as a participant in the CONSERVATORY FOR THE ARTS DANCE CAMP (the “Program”) that the Participant may engage in, among other things, recreational activities and dance activities. Consentee agrees to assume all risks and liabilities associated with Participant’s participation in the Program and to hold the Conservatory for the Arts DANCE CAMP, its directors, officers, agents, contractors and employees (collectively, “Conservatory for the Arts DANCE CAMP”) harmless from any and all claims, causes of action, losses or damages arising from or as a result of Participant’s participation in the Program, except due to the negligence or wrongful act or omission of the Conservatory for the Arts DANCE CAMP. However, the Conservatory for the Arts DANCE CAMP’s liability hereunder is subject to the extent and limitations of Section 768.28, Florida Statutes, and nothing herein shall be construed as a waiver of the Conservatory for the Arts DANCE CAMP’s sovereign immunity beyond that provided in Section 768.28, Florida Statutes.

Consentee also hereby authorizes the Conservatory for the Arts DANCE CAMP to photograph, record, tape, film or electronically capture in permanent form the Participant and Participant’s name, likeness, image, voice, biographical and personal information, appearance and/or performance, and/or further to use and publish the writings of Participant (collectively, the “Work”).

Consentee further grants the Conservatory for the Arts DANCE CAMP full permission to edit the original Work as shall be deemed necessary; that the Work and Participant’s name may be used, published and distributed, without remuneration to Consentee in whole or in part, for educational, instructional, advertising or promotional purposes in print or over open broadcast, cable, audio-visual, radio, closed circuit exhibition, computer link, Internet or other medium as deemed appropriate by the Conservatory for the Arts DANCE CAMP, in perpetuity, throughout the world. For these purposes, Consentee waives and relinquishes my rights and the rights of the Participant with respect to any personal rights, privacy rights and protections, including, but not limited to, those rights under the Family Educational Rights and Privacy Act of 1974, as Amended (FERPA), Section 1002.21 and 1002.22, Fla. Stat., Section 23 of Article I of the Florida Constitution and The Board of Trustees Conservatory for the Arts DANCE CAMP. Said Work shall become the sole property of Conservatory for the Arts DANCE CAMP and may be copyrighted in its own name or name of its choosing.

Consentee also releases the Conservatory for the Arts DANCE CAMP from any and all claims for libel, slander, invasion of privacy or other claims based on Participant’s appearance and/or performance and the recording of such, and agrees to hold the Conservatory for the Arts DANCE CAMP harmless from any and all claims by third parties, including any claim based on an allegation of copyright infringement related to Participant’s appearance or performance.

The Conservatory for the Arts DANCE CAMP also encompasses the Tarpon Springs GUARD CAMP and Conservatory for the Arts GAME DAY Camp.

I represent that I am the parent or guardian of the above named minor Participant and have the authority to execute this Conservatory for the Arts DANCE CAMP Consent and Release. I hearby consent to the foregoing on behalf of the above named participant.

Parent Initials acknowledging the above statement *

Please sign here to acknowledge consent and confirmation that all of the information entered above is correct: *

clear

PayPal

The next page requires you to pay through PayPal. Your registration will go through to the staff as soon as you click below, however, you will not be considered officially enrolled until your PayPal transaction is complete. You will receive an email from Conservatory for the Arts Dance Camp as well as PayPal!