SUMMER CAMP REGISTRATION:
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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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
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