PURPLE DEER MUSIC ACADEMY OF FAIRFIELD SUMMER CAMP AUGUST 21 - AUGUST 25 8:30AM-12:30PM REGISTRATION FORM

Camper #1 First and last name *

School and grade *

Date of birth *

Does this camper have any allergies, medical or behavioral concerns? If yes please explain and if not then type NO. *

Camper # 2 First and last name (if no second camper type NO in this box and the next few) *

School and grade *

Date of birth *

Does this camper have any allergies, medical or behavioral concerns? If yes please explain and if not type NO. *

Parent's name *

Parent's mobile phone *

Address *

City *

State *

Zip code *

Emergency contact and phone number *

Email *

Who can pick up your child from camp? *

Is there anyone who should NEVER pick up your child from camp? *

What you need to know

Camp drop off is at 8:20am and camp starts at 8:30am. Camp is over at 12:30pm and all campers must be picked up before 12:40pm. You must come to the door to pick up your child.

All campers will receive a nut free snack and juice each day around 10:30am. Please notify us of any allergies so we can provide dairy and/or gluten free options if necessary. Breakfast and lunch will not be served.

Everyone will participate in music activities, exploring different instruments, singing, dancing, acting and drawing as well as other fun games. We will be split into small groups for these activities.

At the end of the week, everyone will take home something they created.

Liability waiver

Permission for Enrollment and Release and Waiver of Liability

I am an adult over 18 years of age. I acknowledge and grant consent for my child to participate in all Purple Deer Music Academy of Fairfield's activities. I understand that even when reasonable precautions are taken, accidents can sometimes happen. Therefore, in exchange for Purple Deer Music Academy of Fairfield allowing my child to participate in Purple Deer Music Academy of Fairfield's activities, I understand and expressly acknowledge that I, on behalf of myself, my child, and my child’s next of kin, legal representatives and assigns, do hereby waive and release from liability and covenant not to sue Purple Deer Music Academy of Fairfield, its directors, staff members, students, affiliates, volunteers and guests, and any other person acting for or on behalf of Purple Deer Music Academy of Fairfield, for any loss, damage, or claim of any type, both present and future, including but not limited to, negligence, loss or damage to personal property, personal injury, illness, accident, death, medical costs and any other claims arising out of or relating to my child’s participation in Purple Deer Music Academy of Fairfield's activities.

I understand that it is my responsibility to inform the camp director if my child suffers from any allergies, medical conditions or illnesses. I will take responsibility to keep my child home from camp in the event of illness.

Agreement

I have read this form and am voluntarily granting permission for my child to participate in all activities provided by Purple Deer Music Academy of Fairfield.

Signature *

clear

Student Participation Agreement

As a participant in our camp, your child will learn in a safe and encouraging environment that is based on mutual respect and cooperation. To provide this environment it is important that everyone agrees to the following guidelines. We want every camper to have an awesome experience.

Please take a moment to review this with your child.
As a participating camper at Purple Deer Music Academy of Fairfield, my child agrees to:

Listen
Be kind to others
Use polite and appropriate language
Be willing to take direction and instruction
Stay focused on the activity
Interact and engage with others

Students who cannot comply with the above or whose behavior remains inappropriate into the second day will be asked to leave the program.

I have discussed the above with my child and I agree to the requirements of participation outlined above

Signature *

clear

COVID-19 Policies and Procdures

We will follow all current state guildelines concerning Covid-19 safety whatever they may be at the time.

COVID-19 Policy Agreement

I agree to current Covid-19 policies and procedures

Signature *

clear

Credit Card Information

The cost for attending one week of summer music camp at Purple Deer Music Academy of Fairfield is $375.00. When you submit this form you will be charged a non-refundable $50 registration fee.

The remaining $325 will be charged on August 15th. There are no refunds once payment is processed. However, you may register for and apply the $325 to private music lessons at our academy.

I agree to the above terms and give Purple Deer Music Academy of Fairfield permission to charge the credit card below as stated above.

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Code *

Zip code *