HAUNT CAMP Registration FormParent or guardian, please fill out one form per student. Student Name * First Name Last Name Age of Student * Date of Birth * MM DD YYYY Student Phone (###) ### #### Student Email Parent/Guardian Name * First Name Last Name Parent/Guardian Phone * (###) ### #### Parent/Guardian Email * Is it okay for JCAC staff to use text messaging to contact you in regards to this class? * Yes No Name of person (if other) to contact in an emergency First Name Last Name Emergency Contact Number * Relationship to Student * Does your child have any known allergies? * Yes No If Yes, what? Does your child have any special physical, nutritional, learning, or other needs? * Yes No If Yes, what? Current medication your child is taking Student's Physician Name & Phone Number Student's Dentist Name & Phone Number In Case of Emergency, I authorize JCAC staff to contact my child's physician, dentist, and/or Emergency Medical Services * Yes No HAUNT CAMP will be releasing content on social media! My child may be photographed/videotaped by the program for promotional purposes, as stated in the Photo/Videotape Release Form. * Yes No Students can opt to "check out" a free subscription to the Stan Winston School for Character Arts, which offers a catalog of instructional videos for filmmaking, fabrication, and special effects skills. I give my child permission to access this subscription. * From the website: "Our courses span a wide range of techniques and are geared to varying levels of maturity and skill sets. We feel that even our most basic courses would probably require at least a 7th Grade (13-year-old) level of comprehension. If you are a parent with concerns about appropriate language and imagery (realistic depictions of gore, occasional adult language), it might be best to review specific courses before sharing them with your younger children." Yes No I have read and/or had it explained to me the information contained within the Liability Release & Program Registration Form. I acknowledge my agreement and participation for my child in the program. * Yes No Thank you! We’ll be in touch.
