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2024 Cha Cha Percussion Summer Camp Registration & Policy Form
Camp Time & Date
9-4 PM, Monday-Friday 6/17-6/21/2024
Camp Address
3675 Payne Ave, San Jose, CA 95117
Taiwanese American Presbyterian Church
Please fill out one form per student
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* Indicates required question
Student's Full Name
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Age
*
Kindergarten is required
Your answer
Gender
*
Male
Female
School Attend
*
Your answer
Grade
*
Your answer
Percussion or music learning experience?
*
If yes, please describe briefly in the
next question
Yes
No
Percussion or music experience
Your answer
Parents/Guardian’s Name
*
Your answer
Parents/Guardian’s Cell Phone
*
Your answer
Home Address
*
Your answer
Email
*
Your answer
Emergency Contact Person Name
*
Other than parent
Your answer
Relationship
*
Your answer
Emergency Contact Person Cell Phone
*
Your answer
Extended care 4-6 pm?
Please select, $40 a day
MON
TUE
WED
THU
Total tuition fee
*
(Tuition + extended care)
Your answer
Please note:
In order to secure the Summer camp spot, full tuition must be paid
within 10 days after completing this form.
*
Agree
Required
Food allergies?
*
Describe briefly in the next question if the answer is Yes
Yes
No
Food allergies description
Your answer
Medical conditions or any special attention?
*
Describe briefly in the next question if the answer is Yes
Yes
No
Medical conditions or any special attention
Your answer
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