One Week Mini Camps Enrollment Form
Email address *
STUDENT INFORMATION
First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Grade *
Your answer
School *
Your answer
Student's Cell Phone
Your answer
Student's Email
Your answer
Shirt Size *
Pant Size *
Shoe Size *
Your answer
Allergies
Your answer
PARENT/ GUARDIAN INFORMATION (1)
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Cell Phone *
Your answer
Home Phone
Your answer
Email *
Your answer
PARENT/ GUARDIAN INFORMATION (2)
Optional - If different from above.
First Name
Your answer
Last Name
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Cell Phone
Your answer
Home Phone
Your answer
Email
Your answer
EMERGENCY CONTACT INFORMATION
(other than parent)
First Name *
Your answer
Last Name *
Your answer
Relationship to Student *
Your answer
Cell phone *
Your answer
Home Phone
Your answer
Please select which session or sessions you'd like to attend below. NOTE: WILLY WONKA and ANNIE are SOLD OUT. *
Required
2019 Mini Camp enrollment fee is $300. Please select one of the following options: *
PAYMENT INFORMATION
Once you have selected a payment option we will send you an invoice, which can be paid by either check or credit card. If you selected to request scholarship assistance, we will send you a scholarship assistance form in addition to an invoice for $60. If paying by check, our mailing address is as follows.

23 Elephants Theatre Company
PO Box 1939
San Anselmo, CA 94979
Please list any conflicts that you may have with the rehearsal or performance schedule. *
Your answer
MEDICAL AUTHORIZATION/ PHOTO RELEASE: By checking this box, I hereby agree to indemnify and hold harmless 23 Elephants Theatre Company and its officers and employees from and against any and all liabilities for any injury which may be suffered by me or my child arising out of or in any way connected with participation in the program noted above. In case of an emergency, my child may be treated by a qualified physician. I give 23 Elephants Theatre Company permission to use photographs and/or videos of my child in brochures or publicity. *
Required
REFUND POLICY: If there is insufficient enrollment, the production/ class will be cancelled and your money refunded. Withdrawal from the production/ class will incur a $50 fee (this does not apply to Early Bird specials, there are no refunds for Early Bird pricing). The $30 registration fee is nonrefundable. Withdrawal requests must be made by Monday, May 15, 2018. NO REFUNDS WILL BE ISSUED AFTER MAY 15. *
Required
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service