Broadway Jr Camp 2023

Broadway Jr Camp

Ages 6-12 Pegasus Playhouse 402 Main St Springfield
Actors Information
Actor's Name

First Name Last Name
Birth Date

Month Day Year
Grade
Gender

Male Female Non Binary
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Information
Name

First Name Last Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number
Alt. Phone Number
Does the actor have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the actor prescribed an inhaler? If yes, please explain any instructions.
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 coaches 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

Tuition For Broadway Jr A Beginner/intermediate Musical Theater experience.

$ 300.00

Total

$ 0.00

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