Camp In The Park Registration Form -- "The Boundless Bard"  (entering 4th-6th grade)
Questions?  E-mail Kerith at hiphoptelestai@gmail.com 
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Child's First & Last Name (use nickname if preferred) *
What Grade Level Is Your child Entering this Fall? *
Required
Has your child participated in any programs with Kerith Telestai in the past? (Check all that apply.)
If your child hasn't worked with Kerith Telestai in the past, how did you hear about Rising Stars?
Adult 1 Name *
Adult 1 E-mail *
Adult 1 Phone *
Adult 2 Name
Adult 2 E-mail
Adult 2 Phone
Any health or learning notes for Kerith? (asthma, diabetes, outdoor concerns, allergies, ADHD, autism spectrum, etc.)
I acknowledge that this camp carries a certain amount of risk, as would any outdoor or movement activity.  In the event that my child should be injured, I assume all responsibility and will not hold Kerith Telestai liable. *
I give my permission for my child to be photographed/recorded without his/her name attached for the purposes of promoting this program. *
I agree to monitor my child's health and NOT send them if they show any symptoms of Covid-19. *
Your registration is not complete without payment.  Tuition cost is $180.  Please pay Kerith Telestai through PayPal in order to secure your child's place.  Thank you.
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