2023 LOUISA SUMMER CAMPS

**ALL FIELDS REQUIRED**

Student Information

Student Name:

Student Age:

Grade of School:

Parent/Guardian Name(s):

Address:

City:

State:

Zip-code:

Phone (of Parent/Guardian)
Home:Please format as xxx-xxx-xxxx

Cell:

Email Address (of Parent/Guardian):

Emergency Contact
Name:

Phone Number:

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Please check the camp(s) for which you'd like to register.

Week 1 June 12-16

Beginner PianoMs. MaracaOn SafariUnderwater Explorers

Week 2 June 26-30

Theater CampAmerica the BeautifulMimicking the Modern MastersSimple Sewing

** After your registration is received, you will get an email with an invoice attached from camps.aspireconservatory@gmail.com. It may take several hours to process your registration. All registrations will be processed in the order received. **
$$ This registration is not complete until payment is received $$.

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How did you hear about Aspire?

FacebookWebsiteNewspaperReferralOther
Please explain other or list person who referred you to Aspire:

Our host church, would like to know how they can care for you. Do you have a home church that you attend regularly?:
YesNo
Where do you attend church?:

Who is your Minister?:

Are you looking for a home church/church family?:
YesNo

Signature of Parent/Guardian (if applicable):

Intitials

Date:

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STATEMENT OF POLICIES

1. I understand that during the course of participation with Aspire! Conservatory, photographs and/or video clips may be taken during lessons, classes and performances which may be used for promotion/publicity.

2. I understand that I my information may be shared with the host church of this program.

3. Release of Liability:
In consideration of entering onto the premises of Louisa United Methodist Church and participating in activities of Aspire! Conservatory conducted on said premises, I agree to assume full responsibility for my activities while present on the premises, and I knowingly and freely assume all known and unknown risks, including but not limited to falls, disease transmission, and acts of other persons on the premises, whether accidental or deliberate. I agree to comply with all rules, regulations and procedures imposed by the leadership of Aspire and Louisa United Methodist Church; and I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Aspire! Conservatory and Louisa United Methodist Church, their officers, directors, employees and other officials with respect to any injury, disability, death, or damage to my person or property, whether caused by the acts of said persons, by others on the premises, or by acts of God.

I hereby attest that I have read the Aspire! Statement of Policies. My signature above confirms my compliance with this document and I understand that I am submitting my signature in digital form.

I accept Aspire's terms and conditions

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