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Spring Break Camp Registration 2018
DEFYING GRAVITY! Registration Form March 19th-23rd, 2018. Tuition is $325.
Student's name (first, last) *
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City *
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Student's Address *
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State *
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Zip Code *
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Best Phone Number *
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Best email *
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Mother's Name (first, last) *
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Mother's phone number *
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Mother's Address *
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Mother's email *
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Father's name (first, last) *
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Father's phone number *
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Father's Address *
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Father's email *
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Student's Age *
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Student's Date of birth (mm/dd/yyyy) *
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Student's gender *
Shoe Size
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T-shirt Size *
School Attending *
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Grade *
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Emergency Contact Name *
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Emergency Contact Phone *
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Emergency Contact Address *
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Emergency Contact Relation to Student *
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Family Physician *
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Family Physician Phone Number *
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Allergies or other medical information we should know about this student. *
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Is your child currently enrolled at Showtime? *
Registration Fee (Returning student discounted fee applies for students attending SHOWTIME in the past 12 months) *
Will you require early care camp hours?(8-9am $10)
Select dates of early care camp hours needed. *
Required
Will you require after care camp hours? (3-6pm $5)
Select dates of early care camp hours needed.
Select the after care hour(s) your camper will require. *
Required
Please provide additional information regarding your extended camp needs if necessary
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Total fees for extended camp hours *
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Would you like for you're child to participate in hot lunch buffet day (Friday only) -$7 *
Required
Name as it appears on Credit Card
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Credit Card Type
Credit Card number *
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Expiration date (mm/yy) *
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3 digit code on back of card OR 4 digit code on the front of American Express Card *
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Billing Address *
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City *
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State *
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Zip Code *
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By checking the box below I authorize SHOWTIME Performing Arts Theatre to charge my tuition, along with any applicable fees which may include: extended care, lunch, class, and/or registration fees to the above listed card. I understand that no refunds will be given for tuition. *
By signing this waiver, I release SHOWTIME Dance and Performing arts Theatre and all of its staff from all claims related to any injury which may be sustained by myself or my child while attending any of our classes, camps or events associated with SHOWTIME Dance and Performing Arts Theatre. I also affirm that I currently have and will continue to carry proper medical, health, hospitalization, and accident insurance, which I consider adequate. Photo release: I understand that as a student, my child may from time to time be included in photos and video-taping of student productions. By signing below, I grant permission for SHOWTIME to use these photos in brochures or promotional material. I understand that no refunds will be given for tuition and fees. I agree to the waiver above by typing my full name (first, last) below. *
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