Please Click to Print and Mail The PDF Form With Payment:    Camp Registration Form                       

Or Copy and Paste To Word:

			    Camp Registration Form 

Student(s) Name: _______________________________________________________ Grade: ______ Age: _______ 

Address:_______________________________________________________________________________________ 

Parent Name: ______________________________________ Email: ______________________________________ 

                                                                                 Waiver and Release of Liability 

In consideration for being allowed to participate in any camp and/or activity held by Academy of Arts and 
Science, I do hereby release, waive, discharge, and covenant not to sue the Academy of Arts and Science, its 
officers, employees and agents from liability from any and all claims resulting in personal injury, accidents or 
illness, and property loss arising from, but not limited to participation in any and all Academy programs. 

_____________________________________________ 		_____________ 

Signature of Parent/Guardian of Minor 			Date 

Does your child have allergies? Yes / No (circle one) Describe allergy:_________________________________ 

_______________________________________________________________________________________ 

Does your child have any special needs that we should be aware of: _______________________________ 

________________________________________________________________________________________ 

In case of emergency, contact: 1)______________________________(___)___________ 

 2)______________________________(___)___________ 

 3) ______________________________(___)__________ 

Mail This Completed Form Along with Check Payable to: 

Academy of Arts and Science, 14204 West 72nd St, Shawnee KS 66216 · (913) 568-8241 

A Confirmation Email with Session Information Will Be Sent to the Email Address Above