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Upcycle: Make a Show from What You Find! Registration Form
Please complete the following form to register for Chester Playhouse's Upcycle! day camp.
This camp runs July 25 - 29 and is appropriate for Ages 7 - 9.
A link to complete deposit payment will follow this application.
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Participant's Name (First and last)
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Your answer
Participant's Pronouns
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He/Him
They/Them
Other:
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Participant's Age
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Your answer
Participant's Birthdate
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DD
/
YYYY
What is the best email address to send information about this camp?
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Your answer
Emergency Contact - Name (First and Last)
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Your answer
Emergency Contact's Pronouns
She/Her
He/Him
They/Them
Other:
Clear selection
Emergency Contact Phone Number
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Your answer
If you'd like us to have any additional info, including a second emergency contact, please provide that information (name, pronouns, phone number) below.
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Your answer
Participant's Family Doctor (First and last name)
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Your answer
Family Doctor Phone Number
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Your answer
Does the participant have any allergies or medical conditions that staff of Upcycle: Make a Show from What You Find! should be aware of?
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Yes
No
Please include all information such as medicine (EpiPen, Antibiotics, Ritalin, etc.); and disorders (asthma, diabetes etc.) The Staff of Upcycle: Make a Show from What You Find! will not administer any medication unless agreed upon in writing.
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Your answer
Off-site Permission: We encourage the group to stay together during any breaks. However, you may grant your child permission to leave the program boundaries attended by staff during breaks, and to leave on their own after class (Please check Yes or No) When your child leaves the program school boundaries, we cannot be responsible for them.
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Yes
No
Photo/Video Consent: We occasionally take photos during our workshops. Do you consent to know that some images or videos of your child may be taken and used for promotional purposes?
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Yes
No
Please advise who is authorized to pick up your child. Please list up to three options. Please include Name, Pronouns, and Phone Number.
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Your answer
Please affirm: I have read and confirmed the above information with the youth who I am registering for this program.
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Yes
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