Peter Pan Jr. Enrollment Form
Email address *
STUDENT INFORMATION
First Name *
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Last Name *
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Age *
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Grade *
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School *
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Student's Cell Phone
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Student's Email
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Shirt Size *
Pant Size *
Shoe Size *
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Allergies
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PARENT/ GUARDIAN INFORMATION (1)
First Name *
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Last Name *
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Address *
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City *
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State *
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Zip *
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Cell Phone *
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Home Phone
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Email *
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PARENT/ GUARDIAN INFORMATION (2)
Optional - If different from above.
First Name
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Last Name
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Address
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City
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State
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Zip
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Cell Phone
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Home Phone
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Email
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EMERGENCY CONTACT INFORMATION
(other than parent)
First Name *
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Last Name *
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Relationship to Student *
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Cell phone *
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Home Phone
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Peter Pan Jr. enrollment fee is $800. Please select one of the following options: *
Peter Pan Aftercare: Pan Arts & Crafts Camp
We are excited to offer aftercare for all our Peter Pan Jr. campers. After care will go from 12pm to 4pm, Monday-Friday. Campers will play acting games, work on sets, and help create props for the show! Pay $250 and get aftercare for all 16 days, or let us know the days you need aftercare and we'll set you up for $20 per day!
Full Pan Arts & Crafts Camp
Pick Your Days Pan Arts & Crafts Camp
PAYMENT INFORMATION
Once you have selected a payment option we will send you an invoice, which can be paid by either check or credit card. If you selected to request scholarship assistance, we will send you a scholarship assistance form in addition to an invoice for $60. If paying by check, our mailing address is as follows.

23 Elephants Theatre Company
PO Box 1939
San Anselmo, CA 94979
Please list any conflicts that you may have with the rehearsal or performance schedule. *
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MEDICAL AUTHORIZATION/ PHOTO RELEASE: By checking this box, I hereby agree to indemnify and hold harmless 23 Elephants Theatre Company and its officers and employees from and against any and all liabilities for any injury which may be suffered by me or my child arising out of or in any way connected with participation in the program noted above. In case of an emergency, my child may be treated by a qualified physician. I give 23 Elephants Theatre Company permission to use photographs and/or videos of my child in brochures or publicity. *
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REFUND POLICY: If there is insufficient enrollment, the production/ class will be cancelled and your money refunded. Withdrawal from the production/ class will incur a $200 fee (this does not apply to Early Bird specials, there are no refunds for Early Bird pricing). Withdrawal requests must be made by Monday, May 15, 2018. NO REFUNDS WILL BE ISSUED AFTER MAY 15. *
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