SBW Holiday Camp 2021 Registration Form Please note that all fields followed by an asterisk must be filled in. Parent/Guardian First Name*
Parent/Guardian Last Name*
E-Mail Address*
Street Address*
City*
Cell Phone*
Child's Name*
Age*
Are you signing up siblings?*
---Select--- No
Yes
If you are signing up siblings, how many children will be attending in total?
---Select--- 2
3
4
Please list additional children's names and ages Please list ADA Accommodations needed Please check the week(s) you wish to participate:* Are you registering for all 5 days?* Transportation To and From Camp*
---Select--- Parent Drop off/Pick up
Walker/Biker
Friend
Approved Child Pick Up (Please list names, phone number, and relation) Emergency Contact (Please list names, phone number, and relation) OPMI Payment Policy* Statement of Understanding* OPMI Liability Waiver*
BY CHECKING THIS BOX, I AGREE THAT I HAVE READ AND VOLUNTARILY SIGNED THIS AGREEMENT ELECTRONICALLY and further agree that no oral representation, statements, or inducement apart from the following written agreement has been made: IN CONSIDERATION of being permitted to utilize the facilities, services and program of ORLANDO PREMIER MUSIC INSTRUCTION, herein after referred to as 'OPMI', for any purpose including but not limited to observation or use of facilities or equipment or participation in any off-site program affiliated with OPMI, the undersigned, for himself or herself and any personal representatives, heirs, children and next of kin, hereby acknowledges, agrees and represents that he or she releases OPMI and its staff members from all liability for an injury, loss or damage connected in any way whatsoever to participation in OPMI activities whether on or off of the premises affiliated with OPMI. He or she understands that this release includes any claims based on negligence.
