SUMMER CAMP REGISTRATION

Music Summer Camp
Sign-up Form

* Indicates required field

Child's Name (Aged 4-8) *

First

Last

DOB *

Grade *

Gender *

Parent/Guardian's Name *

First

Last

Email *

Primary Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

1st Emergency Contact Person

1st Emergency Contact Name *

First

Last

1st Emergency Contact Number *

Relationship to child *

2nd Emergency Contact Person

2nd Emergency Contact Name *

First

Last

2nd Emergency Contact Number *

Relationship to child *

Persons Authorized Pick Up Your Child (Other than parents)

Name *

First

Last

Phone Number *

Relationship to Child *

Name *

First

Last

Phone Number *

Relationship to Child *

Medical

Doctor's Name *

First

Last

Doctor's Phone Number *

1st Choice of Hospital *

Hospital Address *

Line 1

Line 2

City

State

Zip Code

Country

Hospital's Phone Number *

Medical Insurance Company Name *

Policy Number *

If Physician cannot be reached, what action should be taken? *

Additional Information

Any Medical Problems *

Any Allergies *

Any Recent Injuries or Hospitalizations *

Current Medication *

Any Additional Information *

Which weeks would you like to sign up for? Choose any weeks. *

WEEK 3- Aug 5th - 9th, 2024 WEEK 4- Aug 12th- 16th, 2024

Early drop-off option at 8am? *

YES NO

Extended Day option til 6pm? *

YES NO

Do you have any specific requests for your child? *

Terms & Conditions

Camp payments are due in FULL before your child begins.
Registration fees may not be refunded.
If you cancel your camp reservation at least 30 days before the start date, you will receive a full refund. Cancellation received 14 to 29 days before your first day of camp = 50% refund/ 13 or fewer days = 0% refund
BK Music Inc. (KOKO Music DUMBO) will not be responsible for damage to, or loss of, personal property.
Late arrival policy fee: For arrival after designated pickup time, a late fee will be charged.
It is the goal of our program to provide a healthy and safe environment for all participants. If a participant displays any inappropriate behavior, or endangers the health and safety of participants or staff, we will contact the parent/guardian to immediately come to the site. We may suspend the participant from the program or consider permanent termination in extreme situations.

Release: I hereby give my permission for my child to participate in all programs, activities and trips. I understand and fully recognize that risks are involved and I hereby release the BK Music Inc.'s benefactors, or employees from any liability arising out of any injury to my child in the event of a medical emergency or surgical emergency. I do hereby give authority to the program and staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. Furthermore, I understand that payment for medical services is solely the family’s responsibility.
I hereby give permission to the BK Music Inc. to take photographs of me and/or my child to be shown in a video, brochure, advertisement, or internet display for purposes of promoting interest in the KOKO Music DUMBO. I release the BK Music Inc. from any claims resulting from the pictures taken on, before, or after the date of this communication. I do hereby give permission for my child to participate in all activities. I authorize the BK Music Inc. to act as a parent surrogate on my behalf. I realize that itineraries and/or programs are subject to change prior to, and during, the year.

By clicking here, I state that I have read and understood the terms and conditions. *

Agree to our terms and service.

Submit

Music Summer CampSign-up Form

Music Summer Camp
Sign-up Form