Registration

Dallas Young Artists 2017 Registration
$600 per camper
$300 per jr. intern

Parent Name *

First

Last

Address *

Parent Email *

Parent Number *

Parent Cell Number *

Child Name *

First

Last

Child Email *

Child cell number *

Grade Completed *

Child T-Shirt Size *

Medical Consent and Release of Liability

I, the undersigned parent or guardian of this student, a minor, do hereby authorize the directors and teachers of Dallas Young Artists (DYA) and/or Garland Summer Musicals (GSM) as agents for the undersigned to consent to medical treatment in an emergency. I hereby release and discharge DYA and/or GSM from any and all claims for personal injuries. I agree that photographs of this student taken during camp and performances may be used for promotional purposes by DYA and/or GSM, but will not be used by other organization without additional written consent.

Emergency Contact *

First

Last

Phone Number *

Emergency Contact *

First

Last

Phone Number *

Insurance Company *

Policy Number *

Policy Holder Name *

First

Last

Phone Number *

Is the participant currently under a doctor's care or taking medication for a diagnosed condition? *

Yes. Details below. No

Please provide medical information here. *

Payment ($600 for campers - $300 for jr. interns) is expected on or before the first day of camp (June 13).

Mail Payment to:
DYA-GSM
PO Box 462049
Garland TX 75046

OR

For credit card call Brenda Rozinsky at 214/394-8933

Payment *

I understand that payment is due at time of registration.

Submit

Dallas Young Artists 2017 Registration$600 per camper​$300 per jr. intern

Dallas Young Artists 2017 Registration
$600 per camper
$300 per jr. intern