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Libertyville Showstoppers Camp 2019
9:00am-3:00pm each session

SESSION ONE: 6/10 - 6/21
SESSION TWO: 6/24 - 7/5 (No Camp July 4th)
SESSION THREE: 7/8 - 7/19
SESSION FOUR: 7/22 - 8/2

$595 per session
$150 Deposit Due with registration

New Student *
Student Name (First and Last) *
Your answer
Which Weeks? *
Required
Grade (In Fall) *
Your answer
Parent/Guardian Contact 1 *
Your answer
Phone number (cell) *
Your answer
Phone number (home)
Your answer
Phone number (work)
Your answer
Parent/Guardian (Contact 2) *
Your answer
Phone number (cell) *
Your answer
Phone number (home)
Your answer
Phone number (work)
Your answer
Student's Doctor's Name and Number *
Your answer
Please list all student allergies and necessary medical supplies i.e. EPI-Pen etc. (even minor allergies, better safe than sorry!): *
Your answer
Please list any/all medical information or behavioral health information for your student: *
Your answer
Photo Release Permission
I, the undersigned parent/guardian, grant permission to The Improv Playhouse Theater and its staff, administrators, and parent volunteers to use my child's name and image in any publicity. I understand that publicity may include both print and electronic means for the purpose of informing the community of events, program advertisement, production sales and distribution, or other promotional publicity. This includes, but is not limited to newspapers, brochures, show posters, The Improv Playhouse website, The Improv Playhouse Facebook page, and The Improv Playhouse Constant Contact emails.In checking the box marked "YES - I DO grant permission" I am giving my written consent to release my child’s name and image to The Improv Playhouse for the aforementioned promotional purposes.
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