Children'S Chorus Of Maryland & School Of Music Day Camp Health Form

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CHILDREN’S CHORUS OF MARYLAND & SCHOOL OF MUSIC DAY CAMP HEALTH FORM
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Questions ? Call us at 410-494-1480 or email at
This form must be completed and turned in before a child can attend this camp. Please mail to Children’s
Chorus of Maryland & School of Music, 320 East Towsontown Blvd. Terrace Level, Towson, Maryland 21286.
Forms may also be faxed to 410-494-4673.
Today’s Date: ______________
Child’s Last Name _____________________________________________ First name ___________________________
Age _____ Date of Birth _______________
Child’s home street address __________________________________________________ Home Phone ____________
City _______________________________________________________ State __________ Zip Code _______________
School __________________________________________________ _______Grade entering in Fall 2016___________
PARENT’S OR LEGAL GUARDIAN’S NAME(S) REQUIRED
1. Parent or Legal Guardian’s Name ____________________________________________________________________
Address_______________________________________________________ State________ Zip Code _______________
Home Phone ______________ Cell Phone
Email Address ______________
__________________________
___________________
Employer_____________________________________________________________ Work Phone _________________
2. Parent or Legal Guardian’s Name ____________________________________________________________________
Address_______________________________________________________ State ________ Zip Code_______________
Home Phone __________________________ Cell Phone __________________ Email address _____________________
Employer__________________________________________________________________ Work Phone _____________
EMERGENCY CONTACTS
:
Please check if you wish to call Parent/Guardian 1. first ________OR call Parent/Guardian 2. first ________
List Adults (other than parents) who may be contacted in case of an emergency situation.
DO NOT LIST Parents in this section.
1. ________________________________________________________________ Phone ___________________________
Relationship to child ________________________________________________ Cell Phone _________________________
2. ________________________________________________________________ Phone ____________________________
Relationship to child _________________________________________________ Cell Phone _________________________
3. ________________________________________________________________ Phone ____________________________
Relationship to child _________________________________________________ Cell Phone _________________________

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