Galaxie 'Vaudeville' Day Camp
We are so excited that you are interested in joining us for our Galaxie 'Vaudeville' Day Camp!
Please complete the attached registration form.

Event Address: 4437 N Ravenswood Ave, Chicago, IL 60640
Contact us at (312)479-1390 or ravenswoodloft@gmail.com
Email address *
Guardian(s) / Parent(s) Name(s) *
Your answer
Phone Number *
Your answer
Registration for weeks: *
Child's Name *
Your answer
Child's Age *
Your answer
Additional Child's Name
Your answer
Additional Child's Age
Your answer
Additional Child's Name
Your answer
Additional Child's Age
Your answer
Preferred Drop Off Time (between 8am-9am) *
Your answer
Preferred Pick Up Time (between 4pm-5pm) *
Your answer
I understand that I must adhere to pick up and drop off guidelines, and that late pick-ups will result in an additional fee. *
Required
Do any of the children have any allergies or medical conditions to note? (please specify) *
Your answer
Emergency Contact (Name + Phone) *
Your answer
I understand that video featuring camp activities may be posted/shared on social media and website for promotional purposes only *
I understand that my registration is not complete without 50% deposit payment. Payment link will appear upon completion of the registration form. *
Required
I understand that my deposit is only refundable if there is a State of Illinois restriction effecting the conducting of Galaxie Vaudeville Day Camp during the week(s) I have registered for, ~or~ if my student(s) have tested positive for Covid 19 prior to the week of class. *
Required
I understand that full payment must be received prior to the camp week for my student(s) to be eligible for inclusion. If the full payment is NOT received prior to the camp beginning, I have forfeited my deposit payment. *
Required
I understand my camp fee is transferable through Monday June 8, 2020 (new registrant must complete a registration form) *
Required
I understand that my child/children will be participating in physical activity such as yoga, tumbling, active play, dance and other physical activities and take full responsibility for ensuring that they are prepared to do so. *
Required
I indemnify Ravenswood Loft, Galaxie Chicago LLC and all related subsidiaries for any liability related to my child/children's participation in activities associated with participating in 'Vaudeville Day Camp'. *
Required
I understand that Ravenswood Loft, Galaxie Chicago LLC and all related instructors and assistants will create a safe environment for my student(s) and themselves. I understand that Ravenswood Loft, Galaxie Chicago LLC and all related instructors will not be held with any responsibility regarding the infection of my child or any caregiver of my student(s) of Covid 19 or any other illness during or after Galaxie Vaudeville Camp weeks. I also understand that I will be required to sign, notarize and return a liability release form to a staff member of Galaxie Vaudeville Camp prior to my student participating in any and all activities. *
Required
I understand that my student(s) and any caregivers will be required to wear a mask/protective face covering while at Ravenswood Loft and during any associated times of the camp. I understand that any refusal of my child to wear a protective face covering will result in my student(s) being excluded from activity, and that the emergency contact for my student(s) will be contacted immediately for pick-up. *
Required
I understand that a daily temperature check will be conducted at camp drop off, and that if my student(s) has a temperature of 100 degrees or higher, my child will be asked to return home for the duration of the day. A refund will not be given for that or any other day in which my student(s) are determined to have a temperature of 100 degrees or more. *
Required
How did you hear about this event? *
Comments/Questions
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What is a particular area of interest for your child/children?
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A copy of your responses will be emailed to the address you provided.
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