MMPA 2021 ONLINE SUMMER CAMP REGISTRATION

This is a registration form for MMPA's online summer camps that will be featured in the mornings of the week chosen. Afternoon camps are currently being planned as in-person camps, and will be announced closer to the opening date, depending on current CDC guidelines. By registering for our virtual AM camps, you will be given preference in registration for our PM in-person camps for that week.

STUDENT INFORMATION

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PRIMARY CONTACT INFORMATION

Relationship To Student *
 

SECONDARY CONTACT INFORMATION

Relationship To Student *
 
I agree that I am responsible for paying the full amount of the camp tuition upon registration. Partial payments may result in loss of deposit or spot in the camp. If the tuition is not paid in full, I understand my spot will be freed up for another camper. *
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EMERGENCY INFORMATION

HEALTH INFORMATION

BEHAVIORAL INFORMATION

AM VIRTUAL CAMP SELECTION

MORNING CAMP OPTIONS

CHOOSE ONE OR MORE WEEKS OF 9:00AM - 12:00PM ONLINE CAMPS @ $225 ($200 for each additional class) *

PAYMENT

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PHOTO / VIDEO RELEASE

Mode Music and Performing Arts (“MMPA”) is requesting permission to use images and videos from our programming for the purpose of advertising and for the promotion of our non-profit to charitable foundations so we can continue to provide art classes and music lessons to all children, regardless of income. I hereby allow MMPA to use images of my child in these applications and requests. MMPA will notify me of classes that will be recorded or have screen images captured prior to the class.

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COMPLETION

I, the undersigned parent/guardian of the registrant, acknowledge the possibility that participation in Mode Music Studios activities could result in physical injury to the registrant. I hereby release, discharge and agree to hold harmless Mode Music Studios, its officers, directors, employees, agents and affiliates from any and all claims arising from or related to the registrant’s participation in Mode Music Studios activities. I further authorize Mode Music Studios staff to obtain medical care for my child in case of an emergency. I certify that I have read, understood, and agree to the above conditions, and that the information provided is complete and accurate to the best of my knowledge. *EpiPens will be kept with the First Aid kit at camp. In cases of severe allergic reaction, instructors are trained to administer EpiPen to outer thigh, call 911 and then call parents. Please remember to pick up your EpiPen from staff on the last day. *
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