KIDS-ON-CAMERA REGISTRATION

DO NOT USE THIS REGISTRATION TO ENROLL in TUCSON
TO ENROLL and PAY in TUCSON contact Aimee Gillard at (520) 299-3000 x256, agillard@tucsonjcc.org or visit tucsonjcc.org

THIS FORM is for CALIFORNIA ONLY.
BE SURE TO READ CALIFORNIA KIDS-ON-CAMERA POLICIES FIRST.
To register fill out form completely
.
SAN FRANCISCO ONE-DAY WORKSHOPS
How to Enroll @ Kids on Camera announced in April.

Click here to go back to KIDS-ON-CAMERA's Welcome page.

 
STUDENT(S) INFORMATION
1st Student M F DOB Age
1st Course # & Date 2nd Course # & Date
2nd Student M F DOB Age
1st Course # & Date 2nd Course # & Date
 
PARENTS INFORMATION
Name Address
City State Zip
Day Phone Eve Phone
Fax
Pager/Cell Who's
E-Mail Who's
 
JUST FOR OUR INFORMATION
Where did you hear about us?
What's your primary purpose for attending Kids-On-Camera?Personal Development
TV Commercials/Modeling Both Other
Does your child have an agent? Yes No.
Agent's Name
 
VIDEO & PHOTO RELEASE UNDERSTANDING
I hereby irrevocably consent to and authorize the use and reproduction by KIDS-ON-CAMERA, of and and all photos or videos which have been taken of my child(ren) in class, for promotional purpose of our school (such as our Newsletter, this web site, etc) without compensation to me. I agree that videos or photos are the sole and complete property of KIDS-ON-CAMERA.
SIGNATURE: Sign here after you printed this form.
   
EMERGENCY INFORMATION (other than parent)
In case parent can't be reached.
Name Home Phone
Cell Phone Work Phone
Who other than child's parents is authorized pick up your child?
Name Phone
Indicate what action you want our personnel to take if injury or illness is of serious nature:
1. In the event you can't be reached do you give permission for KOC authorities to obtain medical aids or ambulance services at your own expense? Yes No
2. If NO, what do you want KOC authorities to do?
3. Physician name & phone required
Physician Phone
 
PAYMENT INFORMATION
SUMMER ROSS DAY CAMP
June 26-30, Ages 5-9, $375
Enroll at Ross Recreation www.rossrecreation.org,
VISA, MC, or checks
Ross Office hours: Mon-Th, 9AM-4PM
415-453-6020

SAN FRANCISCO ONE-DAY WORKSHOPS announced in APRIL 
How to Enroll @  Kids on Camera  announced in April


TOTAL AMOUNT ENCLOSED $
 
PAYMENT METHOD
Check** (Check # ) Money Order** Cash
Visa* Master*

 

Card No _______________________________________ Exp. Date_______________
(Print & write in)

I wish to charge $ to my credit card

*CHARGE SIGNATURE
Sign here after you printed this form. 

__________________________________________________________________

VISA, MC, or Check payable to Kids on Camera
SPACE IS NOT RESERVED UNTIL PAYMENT IS RECEIVED.

Print form, then sign and email scanned form to
info@kids-on-camera.com

 

SIGNATURE REQUIRED:
I verify that all information on this form is correct and I hereby release
Kids on Camera from responsibility in the event of personal injury
or loss sustained during any events or activities
associated with or sponsored by Kids on Camera.


Parent Signature (Print and sign here)
 

Date (Print & write in date)
 



QUESTIONS? Call us at: 415-440-4400

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