Rising Stars Summer Camp In The Park Registration Form -- entering 3rd-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
Unisex t-shirt size for camper
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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. *
Registration is not complete without payment.  Tuition cost is $230, and is non-refundable as per Rising Stars policy.  Please pay at www.paypal.me/IdahoRisingStars within 24 hours in order to secure your child's place.  Unpaid registrations will be moved to a waitlist after 24 hours.
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