2013!
YES! I WANT TO MAKE TV THIS SUMMER!
Click the link below for an editable / typeable Application form, you must save the .pdf to your desktop first, then proceed.
Summer Teen Media Camp 2013 pdf Application.pdf
Student’s Name: __________________________________________________
Address: ________________________________________________________
e-mail: __________________________________________________________
Phone: ( )________________ cell: _________________ School: ____________________________________
Birth Date: ______/______/_______ Grade: ____________ Gender: _____________
Parent / Guardian's Name: __________________________________________________
Work Phone: ( )____________________ cell: _______________ e-mail: _____________________
Parent / Guardian's Name: ___________________________________________________
Work Phone: ( )_________________ cell: __________________ e-mail: ______________________
Emergency Contact: ______________________________________ Phone: ( )____________________
I authorize my child to participate in all camp activities, including leaving EBMC facilities while under adult supervision.
I agree that all media produced is exclusive property of EBMC, all rights reserved.
ILLNESS, ACCIDENT, OR INJURY: In the event of a serious illness or injury, I authorize emergency medical care for my child.
I wish my child to be taken to the nearest Emergency Medical Facility, and the following doctor notified:
Doctor’s Name: ____________________________ Phone: ( )_____________________
Insurance Company and Policy Number: ________________________________________
Parent(s) / Guardian(s) Signature: _______________________________________________________ Date: __________ 2013
Summer Teen Media Camp
2013 – July 8-26, 2013
Time: Monday through Friday, 10:00 AM to 2:00 PM
Cost: $850.00 per session
Ages: 13 - 17
Cancellation/Refund Policy: No Refunds
All production and classes located in Berkeley's Downtown Arts District at:
East
Bay Media Center
1939 Addison Street - Berkeley, CA 94704 - 1179
Phone: (510) 843-3699 email: maketv@aol.com
Website: www.eastbaymediacenter.com
Summer Teen Media Camp 2013 pdf Application.pdf