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Summer Camp Registration 2017
Student/Camper's Name (first, last)
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Student's/Campers Address
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City
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State
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Zip
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Best Phone Number
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Mother's Name
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Mother's Cell Phone
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Mother's Address
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Mother's e-mail
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Father's Name
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Father's Cell Phone
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Father's Address
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Father's e-mail
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Student's Age
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Student's Date of Birth (mm/dd/yy)
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Student's Gender
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Student's Street Shoe Size
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Student's T-Shirt Size
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School Attending
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Grade
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Emergency Contact Name (other than above)
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Emergency Contact Phone Number (other than above)
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Emergency Contact Address (other than above)
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Emergency Contact Relation to Student
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Family Physician
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Family Physician Phone Number
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Allergies or other medical information we should know about this student
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Camp Options (Select ALL that apply)
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Is your child currently enrolled at Showtime
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Registration Fee (Returning student discounted fee applies for students attending SHOWTIME in the past 12 months)
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Will you require extended camp hours?
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Which Dates of extended camp hours needed?
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What specific hours are needed each day?
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Number of Friday Lunch Buffets at $7 each:
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Would you're child like to Participate in Summer Classes (only $10 a class as a part of our Summer Special)
Please provide additional information regarding your extended camp needs if necessary
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Total extended camp hours need
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Total fees for extended camp hours ($5 per hour)
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Total camp fees calculated
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Name as it appears on Credit Card
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Credit Card Type
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Credit Card number
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Expiration date (mm/yy)
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3 digit code on back of card OR 4 digit code on the front of American Express Card
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Billing Address
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City
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State
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Zip Code
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By checking the box below I authorize SHOWTIME Performing Arts Theatre to charge my tuition, along with any applicable fees which may include: extended care, lunch, class, and/or registration fees to the above listed card. I understand that no refunds will be given for tuition.
By signing this waiver, I release SHOWTIME Performing Arts Theatre and all of its staff from all claims related to any injury which may be sustained by myself or my child while attending any of our classes, camps or events associated with SHOWTIME Performing Arts Theatre. I also affirm that I currently have and will continue to carry proper medical, health, hospitalization, and accident insurance, which I consider adequate. Photo release: I understand that as a student, my child may from time to time be included in photos and video-taping of student productions. By signing below, I grant permission for SHOWTIME to use these photos in brochures or promotional material. I understand that no refunds will be given for camp tuition. I agree to the waiver above by typing my name below as well as the date and time (example: Your name first and last, mm/dd/yy)
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Questions/Comments?
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