A Taste of RCA Summer 2021

Required

When: July 7-30, Monday through Friday from 9 a.m. until 1 p.m.
Where: Regional Center for the Arts, 23 Oakview Drive, Trumbull, CT 06611

DATA-EMERGENCY-CONTACT INFORMATION

STUDENT INFORMATION

Namerequired
First Name
Last Name
American Indian/Alaskan, Asian, Black, Hispanic, White, Other
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PARENT/GUARDIAN INFORMATION
Parent/Guardian Full Namerequired
First Name
Last Name
EMERGENCY CONTACTS
If parent/guardian cannot be reached
Namerequired
First Name
Last Name
Name
First Name
Last Name
Name
First Name
Last Name
PHOTOGRAPHING
I give permission for my child to be photographed and/or videotaped during Regional Center for the Arts’ classes and/or performances, and for video and/or photographs of my child to be included in, but not limited to, the CES newsletter, webpage, CES Foundation brochures, publications and RCA Facebook page.  This permission will remain in effect for the duration of my child’s enrollment at RCA unless rescinded by me in writing and submitted to the RCA Main Office.
REQUIRED SIGNATURE IF YOUR STUDENT IS TO RECEIVE MEDICATION AT RCA:
I hereby grant permission for the CES School Nurse to give acetaminophen (Tylenol) or ibuprofen (Motrin) to my child for minor discomfort (i.e. headache, menstrual cramps, fever, toothache) in accordance with the standing orders of the CES Medical Advisor. This permission will remain in effect for the duration of my child’s enrollment at RCA unless rescinded by me in writing and submitted to the RCA Main Office.
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