MODE MUSIC STUDIOS 2019 SUMMER CAMP REGISTRATION (AGES 6-11)

Mode Music Studios
3805 Delridge Way SW
Seattle WA 98106
http://www.modemusicstudios.com

STUDENT INFORMATION

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ADULT PRIMARY CONTACT

PRIMARY ADULT Relationship to Student: *
 
SECONDARY ADULT Relationship to Student:
 
I agree that I am responsible for paying the full amount of the camp tuition before the first day of 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

MEDICAL DETAILS

Please list any medications your child currently takes:
 NameDose / FrequencyTaken During Class / CampWill Self-Administer
1
2
3
4
Any medication brought to class/camp should be kept in the student’s backpack.* Let us know if alternative arrangements should be made for any reason. Refrigeration will not be available. If your student cannot self-administer medication, you must make arrangements for a person known to the child to come to camp or class and administer medication.​ Please advise the camp or class teacher of the person’s name and arrival time in advance. If your child needs prompts to take medication, or needs to report on medications taken during class/camp, please make arrangements to have your child carry a cell phone. Instructors cannot be responsible for administering or monitoring student medication.

ALLERGIES

CHOOSE A 9:00AM - 11:30 PM ROCK BAND CAMP @ $350 (with a Saturday 5pm performance at the Skylark)

9:00AM - 11:30PM ROCK BAND CAMPS *

OR CHOOSE A 9:00AM - 12:00 PM THEATER / DANCE CAMP @ $225 OR 10:00AM -3:00 PM MUSIC VIDEO CAMP @ $300 (+ $15 materials fee)

9:00AM - 12:00PM THEATER / DANCE CAMPS *

MAKE IT AN ALL-DAY CAMP? ADD A 12:30-3:30 CAMP $150 extra ($225 for a PM half day)

You can add either a theatre camp or dance camp for only an additional $150 to make a full day! indicate below which camp you'd like to add. *

REGISTER FOR BEFORE / AFTER CARE

PAYMENT

INDICATE THE FULL AMOUNT PAYMENT YOU'RE MAKING FOR HALF DAY OR FULL DAY, AS WELL AS ANY BEFORE / AFTER CARE. *

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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