Theater Summer Camp 2022: Registration Form
Tuition: $488+ Material Fee $25

Payment ($513: Tuition + Material Fee) to Ching-Yi Wang (530-665-9321) via Zelle or Venmo. Please include the student's name in the memo.        

*Policy
Campers must cancel 14 days prior to camp start date to receive a full refund (minus $50 service fee). 
We reserve the right to cancel any camp due to any extenuating circumstances. In the event of a cancellation, any families enrolled in the camp will be given a full refund.

No refunds or prorated rates will be granted for any reason once the camp has begun.  Thank you!

Website:https://drwangmusic.wixsite.com/home
Location: 3166 S Sepulveda Blvd, Los Angeles 90034
Sign in to Google to save your progress. Learn more
Email *
Which session would you like to attend? *
Required
Student's Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade
Please List Any Singing or Performance Experience If Applicable.
Mandarin Background (Years of Mandarin instruction? in Mandarin immersion program?)
Please Describe Your Child's Personality *
Parents/Guardian's Full Name #1 *
Parents/Guardian's Full Name #2 *
Parents/Guardian Email Address #1 *
Parents/Guardian Email Address #2 *
Parents/Guardian Cell Phone Number #1 *
Parents/Guardian Cell Phone Number #2 *
Parents/Guardian Address *
Emergency Contact and Phone Numbers (if parents not reached) *
Payment Methods *
Required
How did you hear about us? *
Referrer
General Release of Liability Form: I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES being conducted by West LA Chinese Children’s Chorus including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I CERTIFY that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I CERTIFY that there are no health-related reasons or problems which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (1) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: West LA Chinese Children’s Chorus and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; (2) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that West LA Chinese Children’s Chorus and their directors, officers, volunteers, representatives, and agents are NOT responsible for errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people, including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. PARENT OR GUARDIAN OR LIAION OF SUCH, OF A MINOR: I, as parent or guardian or liaison of the above named minor, hereby give my permission for this child or ward to participate in the above named activity, and further agree, individually and on behalf of this child or ward, to the terms as outlined herein. Photograph Waiver: I authorize my child's photo to be used in print, website or official Dr. Wang's Music Studio social media platforms only for advertising purposes. *
Required
Thank you!
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