BE SURE TO READ KIDS-ON-CAMERA POLICIES &
HOW TO ENROLL ON-LINE with REGISTRATION FORM

To enroll fill out reg form completely and sign

DO NOT USE THIS REGISTRATION TO ENROLL IN ARIZONA

CALIFORNIA Registration Form ONLY
All fields with (*) are required.

1st Student
Name *
Sex *
Date of Birth * (Month/Day/Year)
Age *

San Francicso One-Day Workshop
Full payment required: Charge w/ Pay Pal. VISA, AMERICAN EXPRESS, DISCOVER, MC and other cards. If you pay by check mail it by Oct 18 for the Nov. 5 workshops.
NEW Mail Address Fall 2017: PO Box 3031, Tubac Arizona 85646
TV Acting w/Judy Berlin: Sun., Nov 5, 10:00A-12:00P, $150, Age 4-7
 

Voiceover w/ David Rosenthal: Sun., Nov 5, 9:30A-12:30P, $175, Age 8-18

TV Acting w/ Linda DeFilippo: Sun., Nov 5,1:00P-5:30P, $220, Age 7-18  

2nd Student
Name
Sex
Date of Birth (Month/Day/Year)
Age

San Francicso One-Day Workshop
Full payment required: Charge w/ Pay Pal. VISA, AMERICAN EXPRESS, DISCOVER, MC and other cards. If you pay by check mail it by Oct 18 for the Nov. 5 workshops.
NEW Mail Address Fall 2017: PO Box 3031, Tubac Arizona 85646
TV Acting w/Judy Berlin: Sun., Nov 5, 10:00A-12:00P, $150, Age 4-7
 
Voiceover w/ David Rosenthal: Sun., Nov 5, 9:30A-12:30P, $175, Age 8-18
TV Acting w/ Linda DeFilippo: Sun., Nov 5, 1:00P-5:30P, $220, Age 7-18  

Parents Information
Parents Name *
Address *
City *
State *
Zip Code *
Cell Phone *
Day Time Phone *

Emergency Information: other than parent, in case parent can't be reached
Name *
Relationship to child *
Cell Phone *
Day Time Phone *

Who other than child's parents is authorized pick up your child?
Name *
Cell Phone *

Please list any allergies, learning difficulties or medications your child requires?
 

Indicate what action you want our personnel to take if injury or illness is of serious nature:
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?

*

If NO, what do you want KOC authorities to do?
 
Physician name
Physician phone

Just for our information:
Where did you hear about us?
What's your primary purpose for attending Kids-On-Camera?
 
Does your child have an agent?
 
Agent's Name

Releases
Video & Photo Release
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.
*

Hold Harmless
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.
*

Kids-On-Camera Release
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.
*

Payment
Full Payment Due with registration.
In "Qty" box enter number of students enrolled in each class
Qty X Class = Total $
X $150 per student
TV Acting w/Judy Berlin:
Sun., Nov 5, 10:00A-12:00P, Age 4-7

= $
X $175 per student
Voiceover w/ David Rosenthal
Sun., Nov 5, 9:30A-12:30P, Age 8-18
= $
X $220 per student
TV Acting w/ Linda DeFilippo
Sun., Nov 5, 1:00P-5:30P, Age 7-18  
= $
AMOUNT DUE
$
Please note AMOUNT DUE, to write a check or to enter it on the PayPal page
Payment Options: Pay Kids On Camera in Full


*Make check out to "Kids On Camera" and mail by October 18 to:
PO Box 3031, Tubac, AZ 85646
(this information will be repeated on the next page)

By clicking submit you agree to all above releases.

After submitting you will be redirected to the THANK YOU page,
there you find again the PAY BY CHECK information
or you have the opportunity to click on the PayPal button to PAY VIA PAYPAL.



Careful, this will rest the form and clear all data entered.