SUMMER THEATRE CAMP APPLICATION 2020

CONTACT INFORMATION
Participant's Name *

First Name Last Name
Participant's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name of Participant's School *
Name of 1st Responsible Parent/Guardian *

First Name Last Name
1st Parent/Guardian Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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 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.
CAMP INFORMATION
1. Each group will be instructed by certified teachers and qualified adults. The groups will also be assisted by high school and college students.

2. Make sure your child is dressed in comfortable clothes and shoes on camp days.

3. A parent or guardian will be required to sign a release form on the first day of camp before your child can enter. So please bring your child into the building.

4. Payment must be made by July 10, 2019 for your child to be eligible to enter the camp.

5. To pay by cash or check, bring payment to Carthage City Hall,The Panola County Chamber of Commerce or The Texas Country Music Hall of Fame. Make checks payable to The Country Music Hayride.

6. On online payment option is available at the end of the form.

7. See the heading for more information.
Grade for 2020-2021 School Year (ONLY 3rd graders -8th graders) *

3rd Grade 6th Grade 4th Grade 7th Grade 5th Grade 8th Grade
Participant's t-shirt size *

Youth Small Adult Small Youth Medium Adult Medium Youth Large Adult Large
Please choose one area of interest for camping experience *

Light/Sound/Photography/Videography Set Design/Costume Design Acting
Please choose one option:

Camp with lunch-$85 Camp only-$75 (my child will bring a lunch)
PAYMENT OPTIONS

Due to the COVID-19 restrictions, payments will be made at a later date. We will contact you.
SIGNATURE

By signing this form and/or the form on the first day, I acknowledge the rules, payment information and performance requirements.
e-signature *

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CONTACT INFORMATION

MEDICAL INFORMATION

CAMP INFORMATION

PAYMENT OPTIONS

SIGNATURE