Triad Stage Summer Camp Registration Form 2018
Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Address (including city, state, zip) *
Your answer
Student's Age (as of the beginning of camp) *
Your answer
Student's Gender *
Your answer
Student's School *
Your answer
Student's 2018-2019 Grade Level *
Student's Racial or Ethnic Identities *
Required
Please list any allergies or medical conditions that we should be aware of (plus medications and treatments; include doctor's name if necessary). *
Please type "none" if you have no information to list.
Your answer
Please list any disabilities or learning differences (and necessary accommodations) that we should be aware of. *
Please type "none" if you have no information to list.
Your answer
Anything else we should know to help your child have the best experience possible? *
Your answer
What is your goal for your child's experience in camp? *
Your answer
Parent/Guardian 1 Name (First & Last) *
Your answer
Parent/Guardian 1 Relationship to Student *
Your answer
Parent/Guardian 1 Preferred Phone Number *
Your answer
Parent/Guardian 1 Secondary Phone Number
Your answer
Parent/Guardian 1 Email Address *
Triad Stage will use email as a primary form of communication for important camp information. Please ensure that this information is accurate and that the address is checked frequently.
Your answer
Parent/Guardian 2 Name (First and Last)
Your answer
Parent/Guardian 2 Relationship to Student
Your answer
Parent/Guardian 2 Preferred Phone Number
Your answer
Parent/Guardian 2 Secondary Phone Number
Your answer
Parent/Guardian 2 Email Address
Triad Stage will use email as a primary form of communication for important camp information. Please ensure that this information is accurate and that the address is checked frequently.
Your answer
Name of person paying for camp (if different from parents/guardians listed)
Your answer
Emergency Contact Name (First and Last) *
Your answer
Emergency Contact Relationship to Student *
Your answer
Emergency Contact Preferred Phone Number *
Your answer
Emergency Contact Secondary Phone Number *
Your answer
Adults Authorized to pick my child up from camp *
By submitting this information, you authorize Triad Stage to allow these adults to pick your child up from camp. Please list ALL adults, including yourself and the student's second guardian, if applicable.
Your answer
Please list the relationship to the student of all adults listed above. *
Please type "none" if you have no information to list.
Your answer
Please list the phone number of each of the adults listed above. *
Please type "none" if you have no information to list.
Your answer
Publicity Approval *
I agree to give Triad Stage permission to use photographs, videos, or audio recordings of my child for marketing purposes.
Liability Waiver *
I indemnify and defend Triad Stage against any and all claims for injuries, damages, costs and expenses, to persons or property, that may arise out of my child's participation in camp.
How did you hear about Triad Stage's Summer Camp program? *
Required
If you answered "other" to the above question, where did you hear about this camp program?
Your answer
Camp Information *
Please select ALL of the camps that you wish to register for. Please ensure that the camps you have selected match your child's age range and interests.
Required
Do you plan to apply for a scholarship? *
Scholarships are awarded on a first-come, first-served basis and based on need. Students applying for scholarships must qualify for free and reduced lunch benefits, whether or not they receive these benefits. You can fine more information about free and reduced lunch qualifications here: http://www.dpi.state.nc.us/newsroom/news/2016-17/20160729-01
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