Story Theater Camp 2022 Registration Form

Story Theater Camp Registration

The Events Center at Fairview Park / 2740 Mt Holly Road, Camden, AR 71701 June 20 - 24 10:00 - 3:00 / Ages 9 - 14 Evening presentation on June 24 at 6:00pm. Camp is $50. An invoice will be sent to your email upon submission of this form. Payments may be made via PayPal or by check to The Events Center at P.O. Box 605, Camden, AR 71711. Please complete registration form prior to June 16 even if payment will be made on the first day of camp.
CHILD INFORMATION:
Child Name *

First Name Last Name
Age *
9-14
T-Shirt Size *

Youth/Adult S, M, L, XL, XXL
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home/Cell *

Area Code Phone Number
Work Phone *

Area Code Phone Number
E-mail *
Emergency Contact

First Name Last Name
Phone Number

Area Code Phone Number
Medical or Other Concerns for your child
Would you like to volunteer to help during camp?
I release The Events Center at Fairview Park from all liability for injuries sustained while my child attends Story Theater Camp.

I release The Events Center at Fairview Park the right to use pictures of my child, pictures of my child's artwork, photographs or video images in all forms and media including for advertising purposes, for an unlimited amount of time.

I am the parent or guardian of the minor named above and have the legal authority to execute the above release. I approve the foregoing and waive any rights in the premises.
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Story Theater Camp $ 50.00
June 20-24 10:00-3:00

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Story Theater Camp Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION: