Registration Form

Medical Release Form

Please complete/submit the Medical Release Form below along with your child's registration and fee(s).

PLAA Medical Release Form
(complete one form for each child)

* Indicates required field

My child has registered for: *

Summer Morning Arts & Music Summer Afternoon Theater Both Summer Programs

Childs Name *

First

Last

Gender *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Name *

First

Last

Parent/Guardian Name (optional) *

First

Last

Phone # *

Phone # (optional) *

Child’s Allergies (food, insects, environmental, other): *

In the event of a medical emergency, Point Loma Arts Academy is hereby authorized to seek appropriate medical treatment from an authorized professional. By signing this document, I acknowledge my understanding that PLAA cannot and does not make any representation or guarantee that any surface or the airspace at Point Loma Community Presbyterian Church will be virus free, or that persons using the facility (including, without limitation, the restroom) will not be exposed to the novel Coronavirus or COVID-19 (parent-signed waiver required per child).

Parent Name (Electronic Signature) *

First

Last

Date *

Emergency Contact (other than parent/guardian) *

First

Last

Emergency Contact Phone # *

Health Insurance Provider *

Health Insurance Policy Number: *

Deposit paid via: *

Please remember that your child's registration is not complete until we receive your $250 deposit or full payment. Thank you.

Submit Medical Release Form

YOUR CART

Medical Release Form

PLAA Medical Release Form
(complete one form for each child)

Remember to pay program fee ONLINE !

YOUR CART

﻿﻿Medical Release Form﻿

﻿PLAA Medical Release Form﻿(complete one form for each child)

Remember to pay program fee ​ONLINE !

Medical Release Form

PLAA Medical Release Form
(complete one form for each child)

Remember to pay program fee ONLINE !