101 Dalmatians Theatre Camp Registration
Camper Name *
Your answer
Rising Grade Level *
Your answer
Parent Name (1) *
Your answer
Parent Phone Number (1) *
Your answer
Parent Name (2)
Your answer
Parent Phone Number (2)
Your answer
Alternate Phone Number
Your answer
Physical Address *
Your answer
Mailing Address (if different from above)
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Relationship to Camper *
Your answer
Other than the Parent/Emergency Contact, who has permission to pick up the camper? (Please list name, relationship, and phone number)
Your answer
A peanut and red dye free snack will be offered to campers each day. Please list any other food allergies or restrictions. (All day campers will need to bring a bag lunch)
Your answer
List any activity restrictions (asthma, injury, etc)
Your answer
Other Special Instruction or Comments
Your answer
Shirt Size (All camper will receive a camp T-Shirt) *
All campers will receive 2 complimentary tickets to be used at one of the performances. Please select which day(s) you would like to use these tickets. Additional tickets may be pre-purchased through the Box Office (864-224-4248). Ticket sales will open to the Public on June 1st, 2019. *
How would you like to receive your music practice CD? *
I hereby grant permission to Electric City Playhouse and its representatives to take photographs, or videos, of my child(ren) during camp activities and the public productions of 101 Dalmatians Kids at Electric City Playhouse, occurring June 17-29, 2018. I further grant to the producers and their representatives the right to reproduce, use, exhibit, display, broadcast and distribute and create derivative works of these images and recordings in any media now known or later Developed. I understand the ECP may indicate character names but will never share the full name of my child(ren) publicly. I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy. I further waive all moral rights. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials. I hereby release, defend, indemnify and hold harmless the producers from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. I am 18 years of age or older and I am competent to contract in my own name. I give ECP permission to use and display these images on Social Media forums, and website domains for promotion and information news. I have read this document before signing below, and I fully understand the contents, meaning and impact of this consent, waiver, indemnity and release. This consent, waiver, indemnity and release is binding on me, my heirs, executors, administrators and assigns. *
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