Voice & Musical Theater Workshop Summer Camp Registration
Please complete the form and payment options for enrollment! Required fields are marked *; all other fields remain optional.
Camper Information
Camper's Full Legal Name
*
First Name
Last Name
Camper's Preferred Name (if different from legal name)
Camper's Date of Birth
*
-
Month
-
Day
Year
Date
Grade Entering
*
Select Camp Week
*
Prior singing, theater, dance, choir, or performance experience
What does the child hope to gain from camp?
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Parent / Guardian Information
Parent / Guardian Full Name
*
First Name
Last Name
Relationship to Camper
*
Parent / Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent / Guardian Email Address
*
example@example.com
Authority to Enroll Child
*
I confirm that I am the parent/legal guardian and have authority to enroll the child in camp
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Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relationship to Camper
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Additional Authorized Pickup Contacts
In addition to yourself, who would you like to grant permission to pick up your child
Authorized Pickup #1 - Name
First Name
Last Name
Authorized Pickup #1 - Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup #1 - Relationship to Camper
Authorized Pickup #2 - Name
First Name
Last Name
Authorized Pickup #2 - Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup #2 - Relationship to Camper
Authorized Pickup #3 - Name
First Name
Last Name
Authorized Pickup #3 - Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup #3 - Relationship to Camper
Authorized Pickup #4 - Name
First Name
Last Name
Authorized Pickup #4 - Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup #4 - Relationship to Camper
Pickup Authorization Acknowledgment
*
I understand authorized pickup adults may be asked to show photo ID and that campers will only be released to a parent/guardian or an authorized adult listed unless written permission is provided by the parent/guardian
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Pickup Restrictions
Is anyone legally restricted from picking up the child? (Supporting documentation will be required)
*
Please Select
No
Yes
If yes, please list the person’s name and relationship to the child
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Medical, Allergy, and Support Needs
Does the camper have any allergies? (NOTE: no food is served at camps but campers may bring a personal snack)
*
No
Yes
If yes, please describe the allergies, severity, and any emergency instructions.
Does the camper have any medical needs or conditions?
*
No
Yes
If yes, please describe the medical needs or conditions.
Will the camper bring emergency medication such as an inhaler or EpiPen?
*
No
Yes
If yes, please describe the medication and instructions. Emergency medication must be labeled with the camper’s name.
Medical / Allergy Disclosure Agreement
*
I acknowledge that I have disclosed all known allergies, medical needs, and emergency medication information relevant to camp participation.
Are there any medical, behavioral, sensory, emotional, learning, social, or physical needs that may affect participation?
*
No
Yes
If yes, please share anything that would help us provide reasonable support your child successfully.
Support Needs Agreement
*
I understand that reasonable support can be offered; however, this is a small-group performing arts camp and is not a one-on-one therapeutic, behavioral, or childcare program. If a camper needs support beyond what can safely be provided, the instructor may determine that camp is not the right fit.
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Photo, Video, and Agreement
Photo & Video Permission
*
Please Select
Yes, my child may appear in photos/videos used for social media, website, email, print, or promotion.
No, please do not use my child’s image in camp media.
Photo / Video Parent Agreement
*
I understand that parents/guardians may not publicly post photos or videos that include other campers without permission from those campers’ parents/guardians.
Parent/Guardian Name (Agreement Section)
*
Electronic Signature
*
Date
*
-
Month
-
Day
Year
Date
Agreement Confirmation
*
I have read and agree to the
Performers Playhouse Policies
and I understand that signing, registering, and submitting payment indicates agreement.
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Payment Method
Debit/Credit Card
Debit/Credit Card with ESA Receipt to apply for reimbursement
Pay with ESA ClassWallet
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Payment
*
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( X )
EARLY BIRD PRICING through May 22nd Performers Playhouse Camp Workshop Registration
$295.00
$
295.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Billing Zip Code
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit Registration
Submit Registration
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