Nerds' Club: March Break Camp
March Break Camp March 11-15 9: 00 a.m.- 4:00 p.m. Extended Hours available at additional cost. Roseneath Theatre is located at 651 Dufferin Street. For any questions or concerns please contact 416-686-5199 ext 227. *** Please note if registering additional siblings please complete this registration form for each child***
Email address *
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Pronoun *
Your answer
Child's Age *
Your answer
Parent/Guardian Full Name *
Your answer
Phone Number *
Your answer
Full Mailing Address (This is for Invoice purposes) *
Your answer
Emergency Contact *
Your answer
Emergency Contact Number *
Your answer
Are there any access needs, challenges, anxieties/fears that staff should be aware of? *
Your answer
Does your child have any dietary restrictions or allergies? *
Your answer
What are your child's 'nerd' passions? *
Your answer
On March 12, 2019 We will be taking a trip to Bloor Gladstone Library. Does your child have a library card? *
Does your child have any experience playing Dungeons and Dragons? *
Does your child have a particular interest or passion? *
Your answer
Please note invoices will be issued after you complete this registration form. Please refrain from sending payments until your invoice is received.
Invoices can be paid via Electric Money Transfer, Cheque and Gift Certificate
Please Confirm Fees applicable with this application form. *
Required
Release Statement
I am the parent or legal guardian of the child mentioned above (the “Student”), who is under 18 years of age. I agree that the Student participate in the full school programs and activities (the “Activities”) of the Drama school of Roseneath Theatre (the “Theatre”). I acknowledge that I must advise the Theatre in writing if the Student is not physically fit to participate fully in the Activities. I also acknowledge that there are risks in participating in the Activities. I agree that, having taken such precautions as in its discretion are deemed advisable, the Theatre will not be held responsible for any injury, sickness or accident to the Student or for any loss or damage to personal property resulting from the Student participating in the Activities. I authorize the Theatre to secure medical care for the Student. If for any reason the Student requires medical attention beyond any first aid furnished by or on behalf of the Theatre, I agree to be responsible for any expenses incurred. I agree to indemnify the Theatre, its officers, directors, agents and employees and save them harmless from and with respect to all suits, actions and prosecutions by reason of any Activity carried out by the Student, whether on or off the Theatre’s property.
Do you agree with this release statement? *
Media Release Statement
I consent to the use of the likeness (including still photographs and video) of the Student in connection with the drama programs of the Theatre and related institutional promotional purposes throughout the world and without any compensation. I expressly release the Theatre, its officers, directors, agents, employees, licenses and assigns from and against any and all claims for invasion of privacy, defamation, infringement of copyright or any other cause of action that may arise out of such use. I hereby irrevocably release the Theatre from any and all claims for libel and invasion of privacy in connection with the foregoing.
Do you consent to the use of photography and video? *
Thank you for Registering!
Please take a moment to check your email! Invoice and more information will be sent shortly!
A copy of your responses will be emailed to the address you provided.
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