2017 Flamenco Kids Camp Registration Form

Flamenco Kids Camp 2017 Registration Packet
June 5-16, 2017
Flamenco Kids Camp is the youth component of Festival Flamenco Internacional de
Alburquerque sponsored by the National Institute of Flamenco. This two-week day camp introduces
children ages 6-12 to the full range of flamenco arts and culture. Flamenco Kids Camp is a fun,
creative outlet featuring classes in dance, guitar, cajón (percussion), cante (singing), Spanish
language, and literacy. Included with the camp tuition, students receive a Kids Camp T-Shirt, tote
bag, and a ticket to attend a world-class flamenco performance held during this year’s 30th
Anniversary Festival Flamenco. The camp concludes with a free performance for friends and
family at the historic Kimo Theater, where students demonstrate all they have learned during the
course of the camp. Remember that space is limited and registration is taken on a first-come/firstserved basis!
Flamenco Kids Camp is held at the Conservatory of Flamenco Arts located at:
1620 Central Avenue SE
Albuquerque, NM 87106
Instructions for Completion of Registration Form:
Applicants must complete the attached registration form in its entirety along with parent/guardian
signature(s). All registration forms are due by Friday, May 19, 2017. NO EXCEPTIONS.
You can mail or hand-deliver paper registration forms along with payment to:
The National Institute of Flamenco
1620 Central Avenue SE
Albuquerque, NM 87106
For more information or if you have questions, please call the National Institute of Flamenco
at (505) 242-7600 or e-mail:
[email protected] or [email protected]
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Flamenco Kids Camp 2017 - Participant Information
Flamenco Kids Camp 2017 Schedule
June 5 – 16, 2017
Camp meets Monday through Friday, 9:00-2:00PM daily; Drop-Off at 8:45am daily
Tuition Rates
$500 – Flamenco Kids Camp 2017 Tuition
$250 – Current Conservatory of Flamenco Arts Students receive 50% off regular tuition plus 10 classes
toward level advancement! Enter promo code kidscamp2017 during check out.
*A limited number of scholarships are available for families with financial need. Please inquire.
Flamenco Kids Camp 2017 Orientation
There will be a required orientation meeting for parents on the Saturday prior to the start of
Camp (Saturday, June 3rd). Details will be mailed and/or e-mailed home to the parents of all confirmed
registered campers.
If you cannot attend the orientation on June 3rd, please plan to meet at 8:30am on the first day of camp for a
brief orientation.
First day Flamenco Kids Camp:
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All parents must walk their child in on the first day – meet your child’s teacher!
Pick up your child’s Flamenco Kids Camp T-Shirt and tote bag.
Pick up a copy of the calendar of camp events, important dates, and performances.
Students bring their supplies for literacy class, labeled with their name (these can be “recycled”
supplies).
Students must bring the following to Kids Camp on a DAILY basis:
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All parents must come in to drop-off and pick-up their children daily.
A sack lunch (something students can carry).
A water bottle labeled with student’s name.
Kids Camp T-Shirt (this must be worn EVERY DAY).
Flamenco shoes (or hard-soled dress shoes).
Tennis shoes or good walking shoes and comfortable clothing.
Sunscreen (to be applied before student comes to camp).
Girls: Flamenco skirt or long skirt and hair pulled back.
Boys: Long pants.
Literacy Class Supply List (Keep in mind, these supplies do not need to be new)
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Three-ring Binder (about 1”)
5 page protectors, 5 subject dividers
Pencil bag/small box for crayons, colored pencils, or markers
Pencils
PLEASE KEEP PAGES 1-2 FOR YOUR INFORMATION.
PLEASE DETACH AND SUBMIT THE REGISTRAITON FORMS ON PAGES 3-7.
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Flamenco Kids Camp 2017 Registration Form
June 5-16, 2017
Completed registration packets must be submitted by Friday, May 19, 2017. NO EXCEPTIONS.
• $500.00 Flamenco Kids Camp 2017 Tuition; $250.00 for current Conservatory of Flamenco Arts students.
Checks payable to National Institute of Flamenco. Credit card and cash payment options available.
• Flamenco Kids Camp 2017 Registration Form
• Publicity Release Form
• Permission for Participation/Authorization for Medical Services Form
• Flamenco Kids Camp T-Shirt size Form
______ Conservatory Student (ages 6-12)
______ Non-Conservatory Student (ages 6-12)
Participant Information
Child’s Full Name: _______________________________________________________________________
Parent/Guardian names: ___________________________________________________________________
Child’s current age: ___________ Child’s date of birth: __________________________________________
Home address: ___________________________________________________________________________
City: __________________________________________________ State: _______ Zip: ________________
Home phone: _________________________________________________________
E-Mail:______________________________________________________________
Parent 1’s work phone/extension: _________________________________________
Parent 2’s work phone/extension: _________________________________________
Where did you hear about Kids Camp? _______________________________________________________
Name of child’s school: ____________________________________________________________________
Emergency Contact Information
If we have to contact a parent during Kids Camp, whom shall we call? At what number can they be reached?
Name: _____________________________________________________ Phone: ______________________
Emergency Contact Information (Please list someone other than a parent)
Name: _____________________________________________________ Phone: ______________________
Relationship: ____________________________________________________________________________
Is anyone other than you authorized to pick your child up from Kids Camp?
______ No
_____Yes
If yes, list name(s): _______________________________________________________________________
Parent/Guardian Signature________________________________________________________ Date____________
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Flamenco Kids Camp 2017
National Institute of Flamenco (NIF)
Permission for Participation/Physical Activity Parent Permission Slip
I, ________________________________, give permission for my child ______________________
(Parent Name)
(Student Name)
to participate in all activities for Flamenco Kids Camp 2017 between the dates of June 5-16, 2017.
An off-site activity will take place as described below:
June 16, 2017
Flamenco Kids Camp 2017 performance at the Kimo Theater in Albuquerque, NM
Estimated Departure – 12:00pm; Parents will pick-up after the performance
Transportation to destination by School Bus/Van
The parent/guardian recognizes that activities and/or trips involve some degree of risk and that the
National Institute of Flamenco cannot guarantee the safety of participants. Knowing this risk, the
parent/guardian grants permission for the student to participate.
My signature evidences that I accept general liability for the participation of my child in the activity
identified above and that I agree to indemnify and hold harmless the National Institute of Flamenco,
its teachers, its sponsors, its governing board, and other participating agents, either jointly or
severally, from and against any and all claims, injuries, damages, losses, costs, or causes of action
that may arise in connection with this activity.
I understand that a student code of conduct will apply during Flamenco Kids Camp 2017. All
Flamenco Kids Camp students and staff who are participating in activities or field trips are expected
display the virtues of respect, citizenship, caring, trustworthiness, fairness, and responsibility.
Students are expected to maintain the highest standard of behavior at all times. Failure to abide by
these guidelines may result in further disciplinary action to include dismissal from the activity or
suspension from Flamenco Kids Camp 2017.
Additionally, I give permission for my daughter/son to be transported to and from all Flamenco
Kids Camp 2017 activities. Students will walk (with adult supervision) to and from select activities.
A school bus/van will be utilized for Flamenco Kids Camp 2017 transportation.
I have read and give my consent to the above statements:
________________________________________________________________________________
Parent/Guardian Signature
________________
Date
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Flamenco Kids Camp 2017
National Institute of Flamenco (NIF)
Authorization for Medical Services Form – Part I
The National Institute of Flamenco (NIF) wishes to avoid difficulties in obtaining medical services for
students who may become ill or injured during NIF-sponsored activities or field trips. As the
parent/guardian of a student participating in a NIF-sponsored activity, it is necessary that you consent,
in advance, to hospitalization, medical attention, and surgery for your child in case an emergency
occurs. You must provide direction if no consent is given.
In the event of illness or injury, a reasonable effort will be made to contact you to obtain consent in advance
of medical services being given. If we are unable to contact you, the coordinator will consent to such services
for your child by acting in your behalf based on written advance authorization. That authorization is in the
consent form below. Selection of a doctor or hospital will be made on the basis of family preference, if
known. If family preference is unknown, the student will be taken to the closest hospital or one consistent
with the existing circumstances.
By signing below the parent/guardian authorizes emergency medical treatment and/or hospitalization
deemed necessary by emergency response or medical personnel.
• If my child has special or medical needs or routinely must take medication, I will complete Part
II of the form on page 6.
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If my child requires prescription medication during the course of the Camp, I will advise the
Kids Camp Coordinator in advance and provide her with a doctor’s order or prescription.
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Special arrangements for the transporting of student medications may be required.
Authorization for Medical Services
I, the parent/guardian of ________________________________ have read the above and hereby designate
the sponsor of the field trip or activity to act in my behalf in the event of a medical emergency. He/She may
authorize such hospitalization, medical attention, and surgery as may be required in an emergency because of
illness or injuries sustained by my child while participating in NIF-sponsored activities. I, the
parent/guardian, hereby assume financial responsibility for transport (ambulance) to hospital, hospitalization,
medical attention, and surgery provided.
_____________________________________________ ________________
Parent/Guardian Signature
Date
IMPORTANT: If you do not give consent for the authorization of medical services, DO NOT sign above.
Please read and sign the statement below.
☐ Limited or No Medical Services Authorized
If participation in field trips or activities is permitted, but medical services are not authorized:
1. PLEASE CHECK THE BOX ABOVE
2. Please attach a written statement of procedures to be followed if your child is injured or ill during the
trip. This form must be in the possession of the sponsor at all times during all trips.
I have read and give my consent to the above statements:
_____________________________________________ ________________
Parent/Guardian Signature
Date
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Flamenco Kids Camp 2017
National Institute of Flamenco (NIF)
Authorization for Medical Services Form – Part II
THIS FORM MUST BE IN THE POSSESSION OF THE SPONSOR AT ALL TIMES
DURING ALL TRIPS.
SERVICES FOR ILL OR INJURED STUDENTS, WHO ROUTINELY MUST TAKE MEDICATIONS,
AND WHO HAVE MEDICAL CONCERNS THAT MAY REQUIRE TREATMENT WHILE
PARTICIPATING IN KIDS CAMP:
1. List any medical concerns that may affect your child’s participation in Flamenco Kids Camp
2017 (voluntary disclosure):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
2. Known Allergies to Medications or Foods:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
3. List any current medications the student is taking:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
4. Prescription medications that need to be taken or administered to student during Flamenco Kids
Camp 2017 hours of operation (June 5-16, 2017, Mon-Fri, 9AM-2PM):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
5. Prescription medications for emergencies. My authorization form (Part I – page 6) has been
completed and attached:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_____________________________________________ ________________
Parent/Guardian Signature
Date
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Flamenco Kids Camp 2017
Photo/Video Consent and Release Form
Without expectation of compensation or other remuneration, now or in the future, I, (the
parent/legal guardian) hereby give my consent to the National Institute of Flamenco, its affiliates
and agents, to use my child’s, ________________________________________, image and
Child Name
likeness and/or any interview statements from my child in its publications, advertising or other
media activities (including the Internet). This consent includes, but is not limited to:
(a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of my
child and/or record his/her voice;
(b) Permission to use my child’s name; and
(c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film,
photograph(s), tape(s) or reproduction(s) of my child, and/or recording of my child’s voice, in part or in
whole, in its publications, in newspapers, magazines and other print media, on television, radio and
electronic media (including the Internet), in theatrical media and/or in mailings for educational and
awareness.
This consent is given in perpetuity, and does not require prior approval by me.
Name of Student:__________________________________________________________
Name of Parent or Legal Guardian: ___________________________________________
Signature:
Address:
Date:
National Institute of Flamenco
1620 Central Ave SE
Albuquerque, NM 87106
(505) 242-7600
www. nifnm.org
[email protected]
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Flamenco Kids Camp 2017
T-Shirt size Form
Student name: ________________________________________________________
Please circle your child’s shirt size and include this with your payment and registration form.
Child Sizes
Adult Sizes
XS S M L
S M L XL XXL
Office Use:
Red Group
Blue Group
Yellow Group
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