TBC Summer Camp Registration – Texas Center for Arts + Academics

SUMMER CAMP REGISTRATION:

Attendee Info.

Please fill out one form per individual

Name *

First

Last

Date of Birth (MM/DD/YY) *

Participant Grade for 2023-2024 school year

School for 2023-2024 school year

Please list any allergies or medical conditions that instructors should be aware of:

Parent/Guardian/Emergency Contact Info.

If a student, please fill out as your guardian's information. If a director, please fill out your emergency contact's information.

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please list any additional adults with permission for pick up:

(Please separate names with commas)

Secondary Emergency Contact (will be contacted if the primary contact is not reachable)

First

Last

If student, please list someone other than your previous contact.

Phone

T-Shirt Size

Camp Info.

Payment Options *

Registration Fee ($150) + Processing Fee - $ 154.65

I consent to enroll my child/self and accept full responsibility of the named student participant and I while on the premises of Texas Center for Arts+Academics. I hereby release and hold harmless TCA+A and all other persons and entities associated from all injuries, sickness and/or damages. It is the policy of Texas Center for Arts + Academics to contact a student's parent/guardian immediately in the event of sickness or injury. In case of emergency, I authorize Texas Center for Arts + Academics to take one or more of the following actions: a) release my child to the non-parent/guardian emergency contact or b) contact emergency medical services to care for or transport my child to a hospital for emergency care. *

I acknowledge

I hereby grant Texas Center for Arts + Academics (TCA+A), and all related entities, full and absolute permission and all rights to copyright, publish, display and use for legal purpose, any or all photographs, video tapes, digital recording and electronic images together with descriptive text or statements in which my child may appear. Texas Center for Arts + Academics has the right to use these images at any time in the future for the benefit of the organization as they see fit, without compensation to the student or parents. This includes, but is not limited to, print and digital media, audio and video recordings and broadcasts. *

I acknowledge

Comment or Message

Total Amount

$ 0.00

Includes Credit Card Processing Fees

Stripe Credit Card *

Card

Name on Card