• International City Theatre
  • Summer Youth Conservatory

    Acting, Singing, Dancing & Playwriting!
  • Student Name


  • Student's Information

  • Child 2 Information

  • Child 3 Information

  • Child 4 Information

  • Child 5 Information

  • Parent or Legal Guardian Information

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  • Be sure your email address is correct so that you may receive updates!

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  • Emergency Contact Information

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  • Student Pick-Up

  • Health Information

  • It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury.  If the information has changed on the first day of camp please see Jordan Gohara at that time.  

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  • Consent & Release From Liability

    Throughout the duration of the camp and during the final performance we will be photographing and video recording.
  • I hereby understand and acknowledge the participation of my child in the ICT Summer Youth Conservatory. The intended distribution of and use for this product is strictly for promotional purposes of this program or in support of ICT’s educational outreach programs.


    I hereby grant permission for International City Theatre and those acting under its permission to copyright,use, publish, display, produce, duplicate, sell and distribute the photographic, video and sound recordings of me, or my child as stated in the description above. I further grant permission for International City Theatre to use segments or portions of the above product for announcements, informational film clips, or other uses necessary to provide information or advertisement for the production.


    I hereby release, discharge, and agree to hold harmless International City Theatre and those acting under its permission from any liability to the extent permitted by the law, for the preparation, distribution, and use of the product, as described above.


    Any questions regarding this form or production should be referred to our main office at (562) 495-4595 x100.

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  • Payment Information

    $425 Registration Fee Due
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        • I understand that the above named student(s) will only be released to the names listed above, an update may be done at registration.

          I certify that my child has my permission to attend camp and participate in all activites.

          I authorize ICT to use my child's picture, testimony, and video in any promotional material (web, print, or media).

          I understand that there are no refunds and all sales are final.

          By hitting submit, you agree to these terms and that you are the parent or legal guardian of the above named student(s), and are over the age of 18. 

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