performing arts summer camp.registration form
TRANSCRIPT
Personal Data Form for Performing Arts Summer Camp 2009
Website: http://www.kofiwalker.com Email: [email protected] Tel: +59 0690 22 92 59 Fax: 590 27 63 83 Page 1 of 4
Print and take a copy of this form with you to the Camp. Also leave a copy at home with a friend or relative.
Personal Information (Please complete form with Blocked Capital Letters)
Full name
Nickname Grade Level
Home address
Home phone
Mobile or cellular phone
Home fax
Home e-mail address
Birthday (MM/DD/YYYY) Current Age
Parents / Guardians Information
Mother’s full name
Father’s full name
Guardian’s full name (If not child’s Parent)
Business Information
Company / Place of work
Business address
Department / Job title
Business phone
Business fax
Your preferred e-mail address
Web page address
Emergency and Medical Information
Since we will be providing basic medical care (only ice-packs and band aids), Parents need to provide emergency contact information. Anything more serious than basic care, parents will be notified via the emergency contact information provided or at your place of work. If we are unable to reach you, an ambulance will be called. PLEASE LIST EMERGENCY CONTACT INFORMATION CAREFULLY.
In case of emergency, contact
Emergency contact’s address
Emergency contact’s phone
Doctor’s name
Doctor’s phone
Doctor’s address
Medical insurance carrier or Card Vitale No.
Blood type
Personal Data Form for Performing Arts Summer Camp 2009
Website: http://www.kofiwalker.com Email: [email protected] Tel: +59 0690 22 92 59 Fax: 590 27 63 83 Page 2 of 4
Personal Information (Please complete form with Blocked Capital Letters)
Known medical conditions
Known allergies
Current medications
Please list any other known medical
condition the student may have.
Field Trips #1 #2 #3 #4
1st Dates July 10th July 17th July 24th July 31st
2nd Date August 7th August 14th August 21st August 28th
Special Needs
This program may not be able to meet all educational special needs, so please list any below so we can make that determination. These will be kept COMPLETELY CONFIDENTIAL. These needs will only be discussed with my assistant(s) / helpers.
Discipline
To ensure that all students have the best experience possible this summer, the following Discipline Action Plan for Fire, Earth, Wind and Water will be in effect for this Performing Arts Summer Camp.
Disruptive in Class If a student is disruptive in class, the student can expect the following consequences.
1st Verbal Warning
2nd Supervised Time Out
3rd Parent phone call
Continuous disruption Student will be removed from the FEWW Camp with no refund.
I am kindly asking that you discuss these consequences with your child at home. During the first week of classes I will also be reviewing these consequences with the students. After reading through this form, please fill out all the sections. If you have any questions, please do not hesitate to contact me directly on 0690 22 92 59 or send me an email at [email protected]
Please note that photos and videos will be taken of all students in this activity and will remain my property for future use in Community Performing Arts Activities.
Personal Data Form for Performing Arts Summer Camp 2009
Website: http://www.kofiwalker.com Email: [email protected] Tel: +59 0690 22 92 59 Fax: 590 27 63 83 Page 3 of 4
Personal Information (Please complete form with Blocked Capital Letters)
Parents’ / Guardians’ Signature
I hereby give my son/daughter permission to participate in the FEWW Performing Arts Summer Camp Program. I have read and understand all the rules and regulations mentioned above.
Parents’ / Guardian’s Signature:
Date:
Activities: Students will participate in all activities listed below.
Dance Dance Technique and Movement including Afro-Caribbean Dance
Speech and Drama Direction and instructions will be given mainly in English but
performance will be in French and in English!
Poetry Poetry writing and recital of students own works using the theme FEWW.
Modeling / Posture Focus will be placed on building confidence in the child, building an awareness of posture and how best to publicly present themselves.
Percussion n Chant The Broadway Musical Theatre will focus on our Creole Traditions of Percussion and Chant using the 5 Gallon Water Bottles.
Costume Designs Students will be introduced to costume designing for film or stage
production. This will be demonstrated in their Fashion Presentation.
Face Painting Introduction to Face Painting using the theme FEWW
Art and Craft Painting, Drawing, Craft, Cartoon or the creation of 3D images.
Field Trips Lé Gallion, Butterfly Farm, Kali’s Beach, maybe the Fire Department TBC!
Tuition: Please indicate your choice by ticking √ A, B or C
June 29th – July 31st, 2009 (Please Calculate your fees in the far right column). Fees Your Fee
Camp I Registration Fee € 15.00
A Full package 4 weeks € 200.00
B - Weekly € 90.00
C - Daily € 25.00
TOTAL 15 % discount is applicable to 2 or more siblings! € 215.00
e.g. √ [A] 4 Weeks = € 215.00
August 3rd – August 28th, 2009 (Please Calculate your fees in the far right column). Fees Your Fee
Camp II Registration Fee € 15.00
A Full package 4 weeks € 200.00
B - Weekly € 90.00
C - Daily € 25.00
TOTAL 15 % discount is applicable to 2 or more siblings!
Personal Data Form for Performing Arts Summer Camp 2009
Website: http://www.kofiwalker.com Email: [email protected] Tel: +59 0690 22 92 59 Fax: 590 27 63 83 Page 4 of 4
Please email this form to [email protected] or fax it to 590 27 63 83 for the
attention of Mr. Kofi Walker.
You may also return the form to the School for the attention of Madam Brookson in an
envelope with payment addressed to my attention. Marked FEWW Performing Arts
Summer Camp.
Herve Williams 1
Concordia, St. Martin
Thanks in advance for your time and interest.