Shine Summer Camp Scholarship Registration Form

Summer Camp Shine Student Scholarship Registration Form

The Shine MSD Summer Camp workshop will provide middle and high school students an opportunity to learn and participate in a range of creative exercises from drama & musical theatre to songwriting or art! This camp will be led by artistic experts who will allow students to truly express themselves and dive deeper into their preferred subjects. All students will collaborate for a 'Shine' finale celebration at the end of the camp!
DATES & TIMES

SESSION 1: JUNE 20 - JULY 1 MONDAY - FRIDAY 9:00 AM - 2:00 PM

BYOL (Bring your own lunch) Pizza will be provided on Fridays.

SESSION 2: JULY 18 - JULY 29 MONDAY - FRIDAY 9:00 AM - 2:00 PM

BYOL (Bring your own lunch) Pizza will be provided on Fridays.

FINALE CELEBRATION (ALL STUDENTS)

Friday, July 29, 6 - 9 PM

LOCATION

Coral Springs Charter, 3205 N University Dr, Coral Springs, FL 33065
Participant Name

First NameLast Name
Birth date

MonthDayYear
Date
Check one or more options that reflect your gender
Are you in Middle or High School?
What school do you attend?
Pronouns?
What session will you be attending?
Ethnicity
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact's Name

First NameLast Name
Relationship
Emergency Contact's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
T-Shirt Size
Do you have any allegeries, food restrictions, medical conditions or disabilities? If yes, please describe.
Is there anything else you would like us to be aware of or take into consideration?
I agree to attend all dates as listed above including the performance on Friday, 07/29 Please list and explain any attendance conflicts with dates
Type "Yes" if you agree
Please briefly describe your need for this financial scholarship.
RELEASE STATEMENT:I understand that the SHINE MSD Summer Camp is held at Coral Springs Charter, and I agree to abide by all its policies. I give permission to use photographs & videos of my child or me for any and all promotional purposes.I/We as an individual or as a parent or guardian of the participants named herein, assume all risk and hazards incidental to the activities and release from responsibility and agree to indemnify and hold harmless SHINE MSD, their officers, directors, independent contractors, volunteers, on site staff and all employees for any illness and injury to me or my children or family members occurring during his/her/our participation in any activities or use of any facilities at/or conducted by SHINE MSD. Bullying or harassment of any form will result in a dismissal from the program. Signing this document means you have read and agree to the terms listed herein.
Attendance is limited. Once your application is submitted Shine MSD will notify you with additional details.
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Summer Camp Shine Student Scholarship Registration Form