Canon 2023 Summer Camp Registration

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Email *

Today's Date *

YYYY

Student Name (First Name Last Name)

Birthday Date *

YYYY

Gender *

Male

Female

Select the camp session you would like to register *

Session I: Art Camp (6/19-6/30) - $800

Session II: Debate & Speech (7/3-7/14), no camp on 7/4 - $720

Session III: Rhythm /World Instrument (7/17-7/28) - $800

Session IV: Guitar & Ukulele (7/31-8/11) - $800

Customized Immersion Camp

Parent 1 Name (First Last) *

Parent 1 E-Mail Address *

Parent 1 Phone No (xxx-xxx-xxxx) *

Parent 1 Address *

Parent 2 Name (First Last) *

Parent 2 Email Address *

Parent 2 Phone No (xxx-xxx-xxxx) *

Parent 2 Address *

Emergency Contact Name (First Last) *

Emergency Contact Relationship *

Emergency Contact Phone # *

For campers aged 5 and older, please upload a copy of their COID-19 vaccination card *

Option 1

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe *

Choose one of the Payment Methods Below *

Paypal: canoneducation@gmail.com *** Please choose "Friends & Family"

Zelle: CanonEducation@gmail.com

Call us at 408.996.8033 to pay over the phone

Please read the following program policy and check for agreement: *

There will be $1/minute per child for late pick up pass 6 PM.

There will be $25 fee for returned check.

Tuition is due at the time of registration.

Cancellation Policy: 1) At least one week's written notice is required for cancellation/withdrawal of any session. 2)Before 6/12/2023, withdrawal charge fee $50. 3) After 6/12/2023 but before your signed session, 80% tuition payment refund will be made. 4) After your signed -up week, NO REFUND will be given.

Required

Informed Consent & Acknowledgement

I hereby give my approval for my child's participation in ant and all activities prepared by Canon during the selected camp. In exchange for the acceptance of said child's participation, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Canon Education, and all its respective officers, agents and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims, against Canon Education, including all affiliates, all participants, sponsoring agencies, advertisers if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities. Some of these injuries include, but are not limited to, the risk or fractures, paralysis, or death.

Untitled Title

CONFIRMATION

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE QUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Name *

A copy of your responses will be emailed to the address you provided.

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