One Eleven's 2021 Summer Theatre Camp Registration Form
CAMP IS NOW SOLD OUT!! USE THIS FORM TO BE ADDED TO THE WAITING LIST IN CASE OF CANCELLATIONS.
Child's First Name
Child's Last Name
Grade (Fall 2021)
T Shirt Type
T Shirt Size
Allergies/Dietary Restrictions/Medical Needs (if none, please type: N/A)
Primary Contact Phone Number
Secondary Contact Phone Number
Family Mailing Address
Family Email Address (This is where most communication will take place, so make sure it is one you check often!)
Secondary Email Address (optional)
Emergency Phone Number (besides those listed above)
$200 (by May 31st)
$225 (by June 7th)
Cash (Mail to: 111 NE Jackson St, Grants Pass, OR 97526.)
Personal Check (Make your check out to One Eleven Theatre Co. Mail to: 111 NE Jackson St, Grants Pass, OR 97526.)
Pay Online (Use PayPal to send your payment to:
, or there's a direct link to pay at
PayPal Email - If paying online, please specify the email used to make the payment so we can match it up in our records.
We are in need of some adults to help with check-in, check-out, watching kids during the lunch hour, and also a full-time camp nurse or "camp mom." If you are able or interested in helping in any of these areas, please check the boxes below, and we will contact you!
Check in (8:30-9:15) for one day or more
Check out (2:45-3:15) for one day or more
Lunch hour kid monitor (11:45-12:45) for one day or more
Full-time camp nurse
Full-time camp mom or dad
Any other notes or questions? Please let us know below! We are excited to have your child join us at camp this year!
LIABILITY WAIVER: (PLEASE SIGN WITH SIGNATURE OF PARENT OR LEGAL GUARDIAN AND TODAY'S DATE.) I hereby enroll my child in One Eleven Theatre’s Day Camp. In signing this application, I certify that he/she is healthy and free of problems that could adversely affect his/her stay or that of other campers at the Camp. I grant permission for the applicant to participate in all planned camp activities. I hereby grant One Eleven Theatre Co. and its agents full authority to take whatever actions they deem necessary regarding my child’s health and safety, and I fully release One Eleven Theatre Co. from any liability in connection there within. In the event of an emergency, I understand that prudent attempts will be made to contact the undersigned immediately. I understand that I will be responsible for payment of all medical and medication bills. I understand that my child must comply with the camp’s rules and standards of conduct and that the organization may terminate my child’s participation in the camp program if he/she does not maintain these standards. One Eleven Theatre Co. is not responsible for lost, stolen, or damaged personal articles. I authorize One Eleven Theatre Co. to have and use photographs, audio and video recordings, and comments of the person named on this application as needed in promotional materials and public relations programming. I individually and corporately agree to hold harmless One Eleven Theatre Co., its volunteers, agents, employees and officers irrespective of any negligent act or omission by One Eleven Theatre Co. and/or those individuals arising from or related in any way to Disney’s Moana Jr. Summer Camp Program. Signature of Parent or Legal Guardian and Today's Date:
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