DFT Holland Center Into the Wild Summer Camp

Camp Fee $225

This camp is specially formulated for the youngest kiddos in our community- ages 4 to 6*. Our staff is busy getting ready to teach a week of fun featuring songs from The Lion King, The Jungle Book, Tarzan, & more!

We’re also planning a dance party, acting games, adventure-themed arts & crafts, a special performance for parents at the end of the last day and so much more!

*Please make sure child is independent to the bathroom.

Child's Name*

First NameLast Name

Preferred Name (if child has one)

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

MaleFemale

Birthdate*

MonthDayYear

Camper's age at camp start date*

Camper's school attending this fall*

Camper's grade in the fall of 2026*

YesNo

Siblings or best friends attending camp? List names of children your camper would like to be grouped together with.

First NameLast Name

Mailing Address (for camp correspondence)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent or Legal Guardian #1*

First NameLast Name

Relationship to Child*

Best Phone Number*

Area CodePhone Number

Parent/Guardian #1 Email Address*

Parent/Guardian #1 Second Email Address (if you have one)

Parent or Legal Guardian #2

First NameLast Name

Relationship to Child

Parent or Legal Guardian #2 Best Phone Number

Area CodePhone Number

Parent/Guardian #2 Email Address

Name of person(s) other than parent allowed to pick up camper.

First NameLast Name

Name

First NameLast Name

Does your child require any special accommodations? If yes, please describe. If no, put N/A.*

Does your child have any medical, physical, emotional, or behavioral conditions which may affect his/her safety while at camp? If yes, please describe. If no, put N/A.*

Does your child have any allergies to food? If yes, please describe. If no, put N/A.*

Would you like us to know anything else about your child? If yes, please describe. If no, put N/A.

Medical Insurer*

First NameLast Name

Health Insurance Plan*

Insurance Group Number*

Insurance Policy Number*

SUMMER CAMP 2026

General Medical Release and Photo/Video Release

Desert Foothills Theater does not provide medical insurance for any participant in any program offered. I, the Parent or Guardian of this camper as registered, a minor, do hereby authorize the directors and teachers of Desert Foothills Theater as agents to consent to medical emergency treatment. I hereby release Desert Foothills Theater and its Board of Directors from any and all claims from personal injuries.

As the parent and/or legal guardian of the camper registered here, I hereby give permission for my student to be given emergency treatment as needed by members of Desert Foothills Theater (DFT). I give permission for the student to be transported by ambulance to an emergency center for treatment. In the event that I, my student’s listed emergency contact, or my preferred physician cannot be contacted, I consent to medical, surgical and hospital care treatment and procedures to be performed for my child by a licensed physician or hospital when deemed immediately necessary or advisable by a physician to safeguard my child’s health. I agree that I will not hold DFT or any member of its staff liable for damages, injuries or losses during the student’s participation with the DFT education programs.

I also consent that camper’s photo or video may be taken and used for any purpose deemed necessary to promote Desert Foothills Theater education program without compensation.

Yes

BEHAVIOR POLICY: If a camper demonstrates overly aggressive or unsafe behaviors, DFT reserves the right to dismiss them from our program before the end of the session and without refund.

CANCELLATION POLICY: 100% refundable up to two weeks before camp. 50% refundable during the two weeks before the first day of camp. No refund once camp has started. ALL REFUNDS ARE SUBJECT TO A $25 PROCESSING FEE.

Yes

Camp Registration Fee*

Holland Center Into the Wild Summer Camp$225.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Please note that charges will come from Foothills Community Foundation (FCF).

Camper's Information

Parent/Guardian Information

Child Pick Up Authorization at The Holland Center, N. Scottsdale

Special Accommodations