GALAXY ARTS CENTER | 2022 Summer Camp Registration
2022 艺术夏令营报名表
Sign in to Google to save your progress. Learn more
Summer Camp Packages (每周活动套餐)
I. 专业训练提高班: 一周2节一对一音乐课 (Tier I: Camp activities & 2 private lessons)
Current Price: $538

II. 专业训练加强班: 一周3节一对一音乐课 (Tier II: Camp activities & 3 private lessons)
Current Price: $608

III. 专业训练冲刺班: 一周5节一对一音乐课 (Tier III: Camp activities & 5 private lessons)
Current Price: $738

IV. 艺术兴趣培养: 只包括夏令营活动 (Tier IV: Camp Activities only)
Current Price: $398

其他专业课 (Extra Private Lessons)
一对一舞蹈课 (Dance): $75
一对一声乐课 (Vocal): $75
一对一美术课 (Art): $75
一对一中文课 (Mandarin Chinese): $50
Payment Methods (付款方式)
STUDENT INFORMATION  学生资料
Full Name (姓名) *
Chinese Name (中文名)
Optional
Gender (性别) *
Date of Birth (生日) *
Optional
MM
/
DD
/
YYYY
PARENT/GUARDIAN INFORMATION  家长资料 (For student under 18 years old)
Full Name (姓名) *
Chinese Name (中文名)
Relationship to Student (与学生的关系) *
CONTACT INFORMATION  联系方式
Address (地址) *
ex. 123 Main St Anytown, NY 12345
Phone Number (电话) *
E-mail (电邮) *
Summer Camp Weeks (Please check all weeks your child will attend) 请选择参加夏令营的日期 *
Required
For your selected weeks, please indicate your desired camp package (请选择夏令营套餐): *
Extra Private Lessons (其他专业课)
Emergency & Medical Contact 紧急 & 医疗联系
Family/Friend and Physician to be contacted in case of emergency:
Family/Friend Name (家人/朋友姓名) *
Phone Number (电话) *
Physician Name (家庭医生姓名)
Phone Number (电话)
Has your child had any physical and/or medical problems that may restrict his/her ability to participate in any type of activities? (请问孩子有没有任何身体或健康问题?) *
If Yes, please explain below:
如果有,请解释:
Does your child have any allergies to food, drinks, and/or medication? (您的孩子对食物, 饮料, 或药物有过敏吗?) *
If Yes, please explain below:
如果有,请解释:
I, and/or my child, hereby acknowledge and agree to attend and participate voluntarily in all Galaxy Arts Center's activities and events. For students participating in dance related activities: I understand that dance training requires a sustained, repetitive, vigorous physical activity, usually performed on a hard or lightly padded surface without protective footwear (i.e. athletic shoes). It is also understood that dance instruction involves kinetic corrections that may include physically touching the student as part of regular class work and rehearsals. I understand that participants engage in a broad range of quick movements, bending, twisting, running, leaping and lifting, which place extreme demands on the human body, including stress of joints and ligaments, repetitive impact, and occasional falls, slips and collisions with other participants and objects. I also understand that Galaxy Dance Academy is not staffed to monitor and supervise the activities of their students at all times, and the tuition does not cover constant supervision. I also understand that there are inherent risks of serious personal injury involved in all of the above activities as well as in the general participation in Galaxy Arts Center activities and events. I voluntarily assume and accept such risks of personal injury and illnesses arising from my child's attendance and participation in such activities and events as well as from me being on Galaxy Arts Center's premises. I hereby release Galaxy Arts Center, their owners, employees, directors, instructors, officers and agents from all actions, claims or demands that I, my spouse, my child, our heirs or representatives now have or may hereafter have for personal injuries or property damage resulting from my child's attendance and/or participation in Galaxy Arts Center activities and events including from me being on the Galaxy Arts Center premises. I agree that this release includes personal injury and/or property damages caused in whole or in part by negligence, active or passive, of Galaxy Arts Center, their owners, employees, directors, instructors, officers and agents. This release does not apply to liability for willful injury or fraud. This permission and release shall remain effective while my child is enrolled and participating in all Galaxy Arts Center activities. *
I give my permission for my child/myself to be included in photography / videos of dance classes and any of our Social Media platforms including but not limited to: our website, Facebook and Instagram as well as in advertising, press releases and any other electronic or print media promoting Galaxy Arts Center. (我允许我的孩子/我自己参与舞蹈课程的摄影/视频和任何社交媒体平台,包括但不限于:我们的网站、Facebook 和 Instagram 以及广告、新闻稿和任何其他电子 或平面媒体宣传美国银河艺术中心。) *
In the case of an accident or injury, I give permission for treatment of my child/myself as deemed necessary by staff or emergency personnel. I also release Galaxy Arts Center and its staff of liability in case of injury or accident. (在发生事故或受伤的情况下,我允许在工作人员或急救人员认为必要的情况下对我的孩子/我自己进行治疗。 我还免除银河艺术中心及其工作人员在受伤或事故时的责任。) *
By submitting this registration form, I acknowledge that: (1) I have carefully read the above agreements, emergency medical authorization, and media/photo permissions. I understand it is a full release of liability, and I agree to be bound thereby. (2) I read and understand the rules and regulations outlined by Galaxy Arts Center have published and I will be expected to abide by. (3) I will and/or assist my child to perform to the best of his/her ability to uphold the highly professional standards Galaxy Arts Center have established.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy