Summer Camp Registration Form

Musician's Name

First Name

Last Name

Parent/Guardian Name(s)

First Name

Last Name

Phone

(###)

###

####

Secondary/Emergency Phone Number

(###)

###

####

Emergency Contact Name (if different from parent))

First Name

Last Name

Does your child have any medical conditions we should be aware of?

Yes

No

Is your child currently taking any medication during the day?

Yes

No

Has your child participated in CYSO before?

Yes

No

Photo/Video Release – "I give permission for my child’s image or performance to be used for promotional purposes."

Yes

No

Medical Release – "In case of emergency, I authorize the camp staff to seek medical treatment."

Yes

No

Behavior Agreement – "I understand that students are expected to follow camp guidelines and show respect to others." *

Yes

Will your child need to be picked up early or arrive late on any day?

Yes

No