Superhero Science Day: PA Day Camp
PA Day Camp: January 18, 2019. 9:00 a.m.- 4:00 p.m. Early Drop Off 8:30 a.m. Late Pick Up 5:00 p.m.
Email address *
Child's Last Name *
Your answer
Child's First Name *
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Child's Preferred Pronoun *
Your answer
Child's Age *
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Parent/Guardian First and Last Name *
Your answer
Mailing Address for Invoice (Full Address) *
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Primary Phone Number *
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Emergency Contact *
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Emergency Contact Phone Number *
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Does your child have any allergies or dietary restrictions? *
Your answer
Are there any access needs, challenges, or anxieties/fears that staff should be aware of in regards to your child? *
Your answer
Does your child have a favorite superhero? If so who are they? *
Your answer
If your child could have any superpower what would it be and why? *
Your answer
Please Confirm Fees applicable with this application form *
Required
Please note invoices will be issued. Please refrain from sending payments until invoice is received.
Invoices can be paid via Email Money Transfer, Cheque (Delivered Day Of), and Gift Certificate
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? *
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