Rag & Bone Shakespeare Camp Registration 2022

Shakespeare Summer Camp Registration

A Midsummer Night's Dream
Camper's Name *

First Name Last Name
Pronoun
Preferred name (if different from above)
Camper's birthdate *

Month Day Year
Date of birth
Primary Contact
Relationship to camper *

Mother Father Legal Guardian
Name *

First Name Last Name
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Daytime phone number *

Area Code Phone Number
Do you have other phone numbers?

Yes No
Work number

Area Code Phone Number
Other phone number

Area Code Phone Number
Preferred E-mail *

Emergency Secondary Contact Information
Name *

First Name Last Name
Daytime phone number *

Area Code Phone Number
Other phone numbers?

Yes No
Work number

Area Code Phone Number
Other phone number

Area Code Phone Number
Relationship to camper *

Mother Father Legal Guardian
Is this person permitted to pick up child from camp? *

Yes No
Others who may pick up your child from camp:

Personal information
Child lives with *

Both parents Mother Father Legal Guardian
Does the child have any allergies; sensitivities; medical, physical or emotional needs we should be made aware of? *

Yes No
If yes, please describe them, and tell us about any medical instructions or accommodations required onsite.