Brenda's Body Shop Registration

CAMP FUNSHINE Registration Form

Child's Name	Birthday
Parent's Name		MMDDYYYY

Address
Address 2
City
State
Zip Code

School	Grade

Home Phone	Work Phone
Cell Phone

Email	Retype Email

Emergency Contact	Emerg. Phone #

IF YOU ARE REGISTERING FOR CLASSES AT ACCIDENT ELEMENTARY PLEASE CHECK THIS BOX:

Medical Release 1. Does your child have any health condition(s), which may require EMERGENCY ACTION when he/she is at class (e.g. seizures, insect allergy, asthma, bleeding problem? Yes No If Yes, Please Describe:
2. Should there be any restrictions of physical activity in class? Yes No If so, specify nature and duration of restriction:
3. In case of an emergency in which you are unable to be reached, do you give your permission for your child to receive any necessary medical attention? Yes No
I, (Parent Name) have enrolled (student’s name) in a FUNSHINE CAMP at Brenda’s Body Shop / Fun & Fitness in 2017. I waive any possibilitiy of personal damage which may be blamed upon such a program in the future and accepts the responsibility for requesting such a program and assistance. I accept complete responsiblity for my child's enrollment and understand that the instructors of the program or sponsoring agency assume no liability. I, also give permission for my child's photo to be used for press releases, brochures, web site i.e. any printed promotional materials. $20 is due on the scheduled day of camp. Cancellations must be received at least three business days prior to the camp date otherwise you will be charged a $15 cancellation fee. (Parent Name) Questions/Comments? Please use the box below to submit any additional questions or comments.

Please Review our CLASS RULES AND POLICIES and TUITION Pages http://www.brendasbodyshop.com/html/kids/policies.html http://www.brendasbodyshop.com/html/kids/tuitionfees.html Yes! I have read the Class Rules/Polices and Tuition Pages and agree to the terms set forth. I understand my private information will remain confidential.

Choose the classes you want: Check mark all that apply: Camp Funshine 2017
- By submitting this form I agree to the terms, conditions, and policies set forth by Brenda's Body Shop