Summer Camp 2024 Reg Form
SUMMER CAMP 2024
June 24 - 28, 2024 9:00am-3:00pm
Venue Address: Lifeway Church: 1120 Highland Dr. Vista, CA 92083
Contact us at: admin@lighthouseplayers.org for any questions in filling out the form. Thank you for your patience.
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Email *
Student Name *
Grade (2024/2025 School Year) *
Age *
Birthdate *
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Parent/Guardian Name(s) *
Phone Number(s) *
Email(s) *
Address *
Shirt Size (please specify youth, men's or women's): *
Who is allowed to pick my child up? *
Learning/Educational Needs (Please list anything we need to know for us to help your child shine their brightest light!) *
Dietary Restrictions *
Required
Please include any allergies especially airborne all families and faculty need to be aware of (i.e. peanut - when packing snacks). *
My child uses an Epi pen and will bring it to camp each day. *
I understand I need to provide my child with a healthy sack lunch, water bottle, and tennis shoes each day of class unless otherwise specified. *
Hold Harmless: I am the parent or guardian of the child named above. I hereby acknowledge that my child could be injured or have an accident while participating in an Arts Class. With this understanding, I hereby consent to allow my child to participate in the Camp/Showcase and release Lighthouse Players as well as Lifeway Church fictitious business name North Vista Baptist Church (the Venue) and all instructors, directors, coordinators, spouses or representatives of the above entity from any liability of claims resulting from any accident or injury occurring to my child. I also agree to identify and to hold above named parties harmless from any liability and expense from any accident or injury that may occur in any manner in connection with the Classes and Showcases. *
Medical Release: My child, named above, has permission to participate in the current Lighthouse Players Summer Camp. The following information is provided so that the adult(s) in charge may contact a responsible person in case of illness or accident during the activity. Emergency Contact Name(s) & Phone Number(s), Doctors Name & Phone Number: *
My child is in good health and may engage in all activities. There will fun rec activities involving water! *
Please describe any important medical information about your child and list ALL medications taken: *
Date of last tetanus shot:
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I give my permission for the adult in charge to take my child to a medical facility, if necessary, incase of an emergency. If none of the above can be contacted, I consent to treatment for my child under the supervision of, and as deemed advisable, by a physician licensed under the MedicinePractice Act. This provides authority pursuant to Section 25.B of the California Civil Code. *
Permission to Photograph and Videotape:  I give permission for my child to be photographed and videotaped for publicity purposes related to Classes and Showcase. I understand that my child’s photo may appear in the newspaper or on the Lighthouse Players' website or on the company's or instructors’ Facebook or Instagram. *
How did you hear about us? *
Friend Discount (Please list friend's full name. Friend must register and pay prior to YOUR $50 discount being refunded.)
A copy of your responses will be emailed to the address you provided.
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