Enzian

APPLICANT INFORMATION
Young Filmmaker's Name * First Last
Date of Birth * MM / DD / YYYY
Grade Entering in Fall 2013 *
5th 6th 7th 8th
Gender *
Male Female
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number * ### - ### - ####
This program is designed to give participants a sense of freedom, respect, creativity, and personal responsibility. Enzian reserves the right to dismiss a camper when his/her actions show disrespect for other people or property. Please indicate that you understand this policy by entering your name and today's date below.
Parent/Guardian *
Date * MM / DD / YYYY
PAYMENT
• Tuition is $500 per child; $475 per child for current Enzian Film Society Members. To join the Enzian Film Society, call 407-644-5625 ext. 323 or visit www.enzian.org/membership.
• Pick-up is at 5:00 PM Mon-Thur and 3:00 PM Friday. A fee of $100/hr will be charged for late pick-ups.
Payment Amount *
$500 $475 (MUST ENTER MEMBER INFORMATION BELOW IF SELECTED)
Member Name First Last
Member Number (If signing up for a new membership with this application, please enter NEW below)
Primary Parent/Guardian Name
This will also be used as the Emergency Contact * First Last
Cell Phone * ### - ### - ####
Work Phone ### - ### - ####
Primary Parent/Guardian Email *
Alternate Parent/Guardian Name First Last
Cell Phone ### - ### - ####
Work Phone ### - ### - ####
In addition to parents/gaurdians the following people are authorized to pick up my child. If the parents/gaurdians cannot be reached, the school may call the following authorized people in the case of no shows or emergencies. Pick up is 5pm Mon-Thurs and 3pm Friday and requir photo ID. Campers will only be released to parents and authorized drivers!

#1 Authorized Driver Name
Phone
#2 Authorized Driver Name
Phone
DIETARY/EMERGENCY/MEDICAL INFORMATION
In addition to bottled water, may we give your child popcorn and soda?
Popcorn
Yes No
Note:
Soda
Yes No
Note:
Please list any food allergies or dietary restrictions your child may have:
Medications/Allergies/Medical Conditions
Child’s Doctor
Phone Number ### - ### - ####
In Case of Emergency
While KidFest camp is a safe enviroment you should be pleased to know that there will be CPR & First Aid certified staff members present at all times. However if further assistance is needed we will call the child's emergency contact number and also take them to

Winter Park Urgent Care: ‎
118 West Fairbanks Avenue
Winter Park, FL 32789
(407) 772-2273

If the ER is necessary we will go to

Winter Park Memorial Hospital ‎
200 North Lakemount Avenue
Winter Park, FL 32792
(407) 646-7000
Please give us the following permission to ensure everyone's safety:

If emergency medical care is necessary, I give full permission for my child to be transported and receive treatment as needed while we are being contacted. I will claimfull responsibility for transportation and treatment. *
Yes, I give permission
Cancellation Policy

Reservation cancellations received by July 1, 2013 are eligible for a full refund. Cancellations received after July 1 are only eligible for a refund if the reserved spot is able to be re-filled. Extenuating circumstances are taken into consideration.
Please type your name below as an e-signature to confirm that you understand and agree with all information on this form and that all data provided is accurate.

Parent/Guardian Signature *
Date * MM / DD / YYYY
YES, I would like to contribute an additional tax-deductible donation to KidFest to help support family programming and camp scholarships for underprivileged children.

Additional Donation Amount (optional): $ Dollars . Cents
Do Not Fill This Out

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Enzian

APPLICANT INFORMATION

PAYMENT

• Tuition is $500 per child; $475 per child for current Enzian Film Society Members. To join the Enzian Film Society, call 407-644-5625 ext. 323 or visit www.enzian.org/membership.

• Pick-up is at 5:00 PM Mon-Thur and 3:00 PM Friday. A fee of $100/hr will be charged for late pick-ups.

DIETARY/EMERGENCY/MEDICAL INFORMATION

In addition to bottled water, may we give your child popcorn and soda?

Cancellation Policy