Wicked Pegasus Camp

Wicked Pegasus Camp

June 26th - 30th 2023 Pegasus Playhouse 402 Main St Springfield
Actors Information
Actors's Name

First Name Last Name
Birth Date

Month Day Year
Preferred Pronouns
Grade
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian Information
Name

First Name Last Name
Home Number

Area Code Phone Number
Cell Number

Area Code Phone Number
E-mail
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
Does the actor have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Pegasus Playhouse during the selected camp. In exchange for the acceptance of said child’s candidacy by Pegasus Playhouse ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Pegasus Playhouse. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Pegasus Playhouse . including all teachers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

My Products

Wicked Camp tuition $ 300.00

All fees for Wicked Camp

Total $ 0.00

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