KIDS & TEENS ON-CAMERA SUMMER SESSION 2008
STUDENT INFORMATION FORM
Payment
in full required to reserve a space for your child.
Classes
are filled on a first come first served basis.
Enrollment
is very limited. Price is $595.00 + Tax
Mail
checks, (address below) in the amount of $623.04, payable to: AAFT
or visit in person with a Visa/Master Card or cash
Student Name:_______________________________Birthdate:_____________Age:____Sex:___
Address:___________________________________________
Home Phone #:_______________________
___________________________________________
Parent/Guardian
Name:________________________________
Phone #:_________________________
Parent/Guardian
Name:________________________________
Phone #:_________________________
Emergency
Contacts:
Name:________________________________
Phone #:__________________Relationship:_____________
Name:________________________________
Phone #:__________________Relationship:_____________
Physician
Name:______________________________
Phone #:_______________Health Plan:_________
Physical
Limitations, Allergies, Etc.:
_________________________________________________________
I/Weunderstand
that promptness and attendance at all classes is necessary to achieve the
personal and educational goals of the AAFT program.
* I/We
further understand that due to the limited enrollment, if our child is unable
to attend the Summer Session for ANY reason, the Academy
offers NO REFUNDS for this program.
Injury/Illness
Authorization
I/We
authorize the AAFT or any of its employees to refer student, if injured or ill,
to my family physician when I or my spouse/other parent cannot be reached. If a
family physician is not designated, I authorize the AAFT or any of its employees
to select a physician.
I/We
understand that the AAFT and its employees shall not be held responsible for
property damages or injuries which may be sustained during participation in the
AAFT Summer Program.
Signature
of
Parent/Guardian:_________________________________________Date:________________
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