BHP Jr. Artist-in-Training Performing Arts Camp
STUDENTS ENTERING 8th-12th grades

July 5-11, 2020

Show to be performed: I HATE SHAKESPEARE!*
*subject to change without notice
If you have any difficulty with this form, please contact us at edu@blackhillsplayhouse.com or call 605-255-4910 ext. 3.
PART 1: SUBMIT FORM (You will receive a confirmation email.)
PART 2: PAYMENT (You will receive an invoice via email that can be paid online or through the mail.)
CAMPER First Name *
Your answer
CAMPER Last Name *
Your answer
Did this camper receive a 2020 Golden Ticket? (an award from Dakota Players)
Has this camper attended a BHP Jr. Camp before? *
CAMPER Gender *
CAMPER Age (at time of camp) *
Your answer
CAMPER Grade in Sept. 2020 *
CAMPER T-Shirt Size *
Roommate Preference? (please list name of child your child would like to room with)
Your answer
Does the child have any allergies/intolerance to food, medication, or any other substances? *
If yes, please list allergies/intolerances and action to take in an emergency:
Your answer
Please list any current medical conditions and/or information you would like us to be aware of:
Your answer
CAMPER's Email (if they have one)
Your answer
GUARDIAN'S Email (primary adult contact for camp information) *
Your answer
ANY OTHER EMAILS for people who should receive general camp information.
Your answer
How do you prefer to receive camp information? *
Street address *
Your answer
City *
Your answer
State, Zip code *
Your answer
Guardian/Emergency Contacts
Guardian/Emergency Contact-1 Name *
Your answer
Guardian/Emergency Contact-1 Phone *
Your answer
Guardian/Emergency Contact-1: Relationship to Child *
Your answer
Emergency Contact-2 Name *
Your answer
Emergency Contact-2 Phone *
Your answer
Emergency Contact-2: Relationship to Child *
Your answer
Media Release for Black Hills Playhouse & Placerville Camp
I grant permission for my image to appear in video or audio recordings, films, photographs, written articles, or on websites and social media sites. This consent includes the use and editing of my image, voice and name in media projects by the Black Hills Playhouse and Placerville Camp to print, broadcast or Internet media outlets, such as newspapers, radio and television stations and news websites. In consideration of the opportunity for me to participate, I release the Black Hills Playhouse and Placerville Camp, including its employees and contractors, from all claims resulting from the use and editing of my image, voice or name, and the use, sale, editing and release to media outlets.
Media Release *
Release of Liability for Camp Participation
I agree to indemnify and hold harmless Black Hills Playhouse (hereinafter referred to as Theatre), its Employees, Agents, Officers, Board Members, Volunteers or any other person against loss or expense, including attorney fees, due to any bodily injury, personal injury or property damage which may result from any and all activities while participating in classes or any other activity sponsored by or conducted by Theatre, or while visiting any facilities owned by, leased by, or controlled by Theatre.

It is understood and agreed that this Release of All Liabilities shall remain in force for not more than one year from the date of this Release. The release is recorded through a computer system, along with the date of agreement.
Liability Release *
Signature
I am a parent/guardian acting on behalf of the above named child under 18 years of age. By typing my name below I am indicating I understand everything above. *
Your answer
Date of Signature *
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Comments:
Your answer
PART 1: SUBMIT FORM (You will receive a confirmation email.)
PART 2: PAYMENT (You will receive an invoice via email that can be paid online or through the mail.)
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