Student's Name *

First Name

Last Name

Sub Sandwich Selection *

Friday night sub dinners are included in your fees!

Turkey

Ham

Roast Beef

Veggie

Parent 1 Name *

First Name

Last Name

Parent 2 Name

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Cell Phone *

(###)

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Parent Home/Work Phone

(###)

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Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Authorization for Emergency Care *

I authorize DSCC to seek medical attention for my student in case of emergency and parent/guardian or emergency contact cannot be reached.

PHOTO/VIDEO RELEASE: *

CHHS Choral Boosters, hosts of Dominion Show Choir Camp, has permission to use photos/video clips of my child for educational and promotional purposes. I understand that children will not be identified by name in any images that are displayed.

Medication Administer Authorization:I authorize DSCC personnel to administer the following medications as needed (dosage per package instructions) to my student:

Ibuprofen (Advil)

Acetaminophen (Tylenol)

Naproxen (Aleve)

Diphenhydramine (Benadryl)

**Please type your name in the field below to accept the terms outlined for Dominion Show Choir Camp. I am aware that my student must have access to a computer and the internet for each day of camp and that my student’s space is NOT guaranteed until my full camp fee has been received by CHHS Choral Boosters.

First Name

Last Name