SUMMER FILM and/or THEATRE CAMP APPLICATION 2022

Camp arrrival times: 8:30am to 9am

Camp departure time: 4pm

Please note: Film Campers departure time on Friday is 12:30pm and return for red carpet premiere of their movie with family and friends at 6PM.

Theatre campers will stay on Friday through show, showtime is 6pm for the performance of the plays for family and friends.
Please choose camp(s)

Film Camp Theatre Camp Film Camp & Theatre Camp
Participant's Name *

First Name Last Name
Grade for 2022-2023 School Year (ONLY 3rd graders -8th graders) *

3rd Grade 6th Grade 4th Grade 7th Grade 5th Grade 8th Grade
Please choose one area of interest for Film Camp experience: *

Light/Sound/Photography/Videography Acting Not attending this camp
Please choose one area of interest for Theatre Camp experience: *

Light/Sound/Photography/Videography Costume/Set Design Acting Not attending this camp
Participant's t-shirt size *

Youth Small Adult Small Youth Medium Adult Medium Youth Large Adult Large
Participant's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of 1st Responsible Parent/Guardian *

First Name Last Name
1st Parent/Guardin Phone Number *

Area Code Phone Number
1st Parent/Guardian Email *
example@example.com
Name of 2nd Responsible Parent/Guardian

First Name Last Name
2nd Parent/Guardian Phone Number

Area Code Phone Number
2nd Parent/Guardian Email
example@example.com
MEDICAL INFORMATION
1. Does your child have any known allergies? *

No Yes
If the answer to question 1 is "yes", please list the allergies.
2. Does your child carry an Epi-pen for allergies? *

No Yes
3. Does your child carry an inhaler for asthma? *

No Yes
4. Does your child have any necessary dietary requirements? *

No Yes
If the answer to question "4" is "yes", please elaborate.
5. If your child has any other medical information that you feel is essential information, please elaborate.
Permission to Photograph/Video-During the course of the camp(s), your child may be photographed and/or on video. This will be used in promotional material on Facebook, in the dvd that will be for sale at the end of camp and/or in the short film. The Panola Watchma will also be taking photos.

Yes, I give permission for my child's photo/image to be used No, my child's photograph/image may not be used
CAMP INFORMATION

A letter and email will be sent to each camper with detailed information before camp. If you have any questions before receiving this please feel free to contact Cindy Deloney at 903-736-2273 or by email at cdeloney@carthagetexas.com
e-signature *

Clear
Please note: if you do not choose lunch now, you can choose to add it for $3/day at check in each morning.
I am paying by:

Credit Card Check or cash

My Products (FOR CREDIT CARD PAYMENTS ONLY):

Film camp (no lunch included) $ 75.00

Film Camp (including lunch each day) $ 85.00

Theatre camp (no lunch included) $ 75.00

Theatre camp (including lunch each day) $ 85.00

Theatre Camp and Film Camp (Including lunch each day) $ 150.00

Theatre Camp and Film Camp (No Lunch Included) $ 130.00

Total $ 0.00

Credit Card

My Product (For cash/check payments only): If paying by cash/check, submit and print this form and take it with your check or cash to Carthage City Hall or The Texas Country Music Hall of Fame

Theatre camp (no lunch included) $75.00 Theatre Camp (Including lunch each day) $85.00 Film Camp (no lunch included) $75.0 Film Camp ( including lunch each day) $85.00 Theatre Camp and Film Camp (Including lunch each day) $150 Theatre Camp and Film Camp (No lunch included) $130.00
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MEDICAL INFORMATION

CAMP INFORMATION

Credit Card