South Tampa Summer Camp Registration Form 2024 SESSION 6

South Tampa Session 6 - 2024

"*" indicates required fields

Student Name*

First Last

Grade (September 2024)*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Parent Name*

First Last

Parent Cell*

Parent Email*

Sibling’s Enrolled in Camp

Allergies/Special Instruction

Authorized Pick Up

Persons Authorized to Pick Up Child - 1

Name

Relationship to Student

Phone

Persons Authorized to Pick Up Child - 2

Name

Relationship to Student

Phone

Summer Camp Fee Per Week : $185.00 Per Student

Terms & Conditions

Media Release

I give my permission for my child to be photographed or videotaped for use in Rockatar Music Academy productions related to print and digital marketing.

Statement of Cooperation And Release

I the Undersigned, Student, Parent or Legal Guardian and member hereby knowingly and voluntarily waives any right of cause of action of any kind whatsoever arising as the result of summer music camp activity from which any liability may or could occur or accrue to Rockatar Music Academy, Inc. and Rockatar Music Academy LLC. and its Officers, Agents, Employees or Instructors. I/we agree to cooperate with the staff and instructors in a supportive manner. As Undersigned there are no refunds or cancellations, and I have read, understand, accept and agree to the above and preceding.

I agree to Terms & Conditions

Please complete this form to reserve camp session.

Credit Card*

Card Details

Cardholder Name

South Tampa Session 6 - 2023

Session 6 - July 22 to July 26

Please check your email (or spam folder) for a Helpful Information email and a receipt once the registration is completed. Please call 8134049194 if you have any questions.