menutest | Napatak Ramble

Child's Information:

Child's Full Name *

How old is your child? *Your child must be 8 to 12 years old

Your child's birth date

Hospitalization Number

Any previous music experience

Parent/Guardian's Information:

Parent or Guadian's Full Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Phone Number

Email AddressPlease provide us an email address to contact you

Emergency Contact Information:

Name

Relationship to childParentGuardian

Phone

Health conditionsDoes the camper have any allergies or health conditions we should be aware of? Is there any medication that will need to be taken while at camp?

Behavioral conditionsDoes the camper have any behavioral conditions we should be aware of?

Waiver:

As a parent/guardian I; a) do hereby authorize the camp to obtain medical care for the health/safety of my child; b) do hereby grant permission for the Napatak Ramble to use any photographs taken of the camper named above for promotion of advertising of the camp; c) will not hold the Napatak Ramble of its staff legally responsible for any incidents which may occur to the camper while at the Napatak Ramble site; d0 have provided all the pertinent information to allow the Napatak Ramble staff/volunteers to care for my child to the best of their ability; e) understand that in order for my child to perform at the Napatak Ramble they must be accompanied by a paying adult.

Parent or Guadian's Full Name *

Date this form is submitted

Presentation One

Child's Information:

Parent/Guardian's Information:

Emergency Contact Information:

Waiver:

Note: As parent/guardian you must sign this waiver at the beginning of camp.