SOTA Kid’s Camp Registration

Camper Information
Check week you are registering for*
- June 12 – June 16
- June 19 – June 23
Campers Name*
First Last
Birthdate*
Address*
Street Address Address Line 2 City State ZIP Code
Food or other allergies/ health concerns
Parent/Guardian
Parent/Guardian Name*
First Last
Phone*
Email*
Emergency Contact 1
Contact Name*
First Last
Phone*
Emergency Contact 1
Contact Name*
First Last
Phone*
Preferences
With my signature below, I give my preference as to whether my child’s photo/video images can be used for publication purposes by SOTA Studios, Inc. This image can be used in print and on the World Wide Web minus the name.
Photo/video Preference*
- I agree for my child’s photo/video to be used
- I do not wish for my child’s photo/video to be used
Liability
Every precaution will be taken for the safety of your camper, however, in the event of accident or injury, my signature below releases SOTA Studio, INC. and SOTA Gallery, Inc. and its staff from any liability.
Please type your first and last name as the signature*

Camper Information