Waxhaw Community Theatre Pure Imagination Camp Registration Form

Pure Imagination Summer Camp Registration Form

CAMP IS FOR RISING 6TH - 9TH GRADERS 5300 NESBIT ROAD WAXHAW, NC 28173
Camper's Information

Personal & Health & Contact
Full Name

First NameLast Name
Birth Date

MonthDayYear
Age (at time of camp)
Grade (entering this fall)
T-shirt Size:
List Any Allergies and Dietary Restrictions
Medications & Frequency
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Information

(All correspondence and and invoices will be sent to this person)
Name

First NameLast Name
Email
example@example.com
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Camper
Emergency Contacts and Authorized Pick Up Persons
Program Information

Program & Transportation & Payment
Terms & Conditions
My Products
Categories:All

All
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July 27th - August 7th -Full 2 Week Camp Theatre Skill & Pure Imagination Performance Intensive$500.00

August 3rd-7th Pure Imagination Performance Intensive$275.00

July 27th - 31st Pure Imagination Theatre Skill Camp$275.00

Total $0.00
Signature
Date

MonthDayYear
Date
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty:

Pure Imagination Summer Camp Registration Form