Clone of Camp Confi(dance) 2026 K-5

Campers Full Name

First NameLast Name

Campers Birthdate

Date

Does your camper have any allergies or medical conditions we should be made aware of? Are there any special accomodations we should know about to make this experience successful?

Is your child potty trained?

Parent/Guardian Name #1

First NameLast Name

E-mail

example@example.com

Contact Number

Format: (000) 000-0000.

Parent/Guardian Name #2

First NameLast Name

Contact Number

Format: (000) 000-0000.

Is there anyone else who may be picking up or dropping off your camper that we should know about?

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How did you hear about us???

If you were referred by a friend please let us know who!

Medical Release and Participation Waiver: Parents, legal guardians of minors and adults waive the right to any legal action for any injury sustained on Level Up Performing Arts Center Property or event resulting from normal class/physical activity or any other activity conducted by the participant before, during or after class time. I have my own medical insurance to cover any and all medical bills or related bills that may arise from the nature of the activity. I release Level Up Performing Arts Center from all financial responsibility from any expense that is incurred for any unfortunate situation that may occur. I also consent to my child's photo being used in any images or marketing by Level Up Performing Arts Center.