Camper Information

    Child's First Name:
    Child's Last Name:
    Date of Birth:
    Age:
    gender:

    Parent / Guardian Contact

    Parent/Guardian's First Name:
    Parent/Guardian's Last Name:
    Relationship to Child:
    Email Address:
    Phone Number:

    Address & Logistics

    Home Address:
    City/Town:
    State:
    Zip Code:
    Emergency Contact Full Name:
    Emergency Contact Phone Number:

    Health & Safety

    Allergies (food, medication, environmental):
    Medical Conditions (asthma, seizures, etc.):
    Medications Taken During Camp Hours:
    Physician's Name & Phone (optional):

    Medical and allergy information is collected solely for participant safety and emergency response. This information will be accessible only to authorized staff and will not be shared outside the organization except in the event of a medical emergency.

    Camp Experience & Needs

    Does your child need any learning or physical accommodations?:
    Any behavioral or sensory considerations we should know about?:
    Authorized pickup people (names + relationship):
    Would you be interested in after-camp care from 3-4pm?: YesNo

    Theater-Specific

    Has your child participated in theater before? YesNo
    If yes, where or in what type of productions/classes?:
    How did you hear about the camp?:

    Signature

    Use you finger or mouse to sign in field below: