Holland Center Beauty and the Beast Summer Camp

Our staff is busy getting ready to teach songs and dances including "Be Our Guest", "Gaston", "Beauty and the Beast" and other hits. We’re also planning a talent show, a dance party, acting games, Beauty and the Beast and French themed arts & crafts, a special performance for parents at the end of the last day and so much more!

Child's Name*

First NameLast Name

Preferred Name (if child has one)

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Gender*

MaleFemale

Birthdate*

MonthDayYear

Camper's age at camp start date*

Camper's school attending this fall*

Camper's grade in the fall of 2023.*

Is this child a returning Desert Foothills Theater Camper?*

YesNo

Siblings or best friends attending camp? List names of children your camper would like to be grouped together with.

First NameLast Name

Mailing Address (for camp correspondence)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent or Legal Guardian #1*

First NameLast Name

Relationship to Child*

Best Phone Number*

Area CodePhone Number

Parent/Guardian #1 Email Address*

Parent/Guardian #1 Second Email Address (if you have one)

Parent or Legal Guardian #2

First NameLast Name

Relationship to Child

Parent or Legal Guardian #2 Best Phone Number

Area CodePhone Number

Parent/Guardian #2 Email Address

Name of person(s) other than parent/guardian allowed to pick up camper.

First NameLast Name

Name

First NameLast Name

Does your child require any special accommodations? If yes, please describe. If no, put N/A.*

Does your child have any medical, physical, emotional, or behavioral conditions which may affect his/her safety while at camp? If yes, please describe. If no, put N/A.*

Does your child have any allergies to food? If yes, please describe. If no, put N/A.*

Would you like us to know anything else about your child? If yes, please describe. If no, put N/A.

Medical Insurer*

First NameLast Name

Health Insurance Plan*

Insurance Group Number*

Insurance Policy Number*

SUMMER CAMP 2023

General Medical Release and Photo/Video Release

Desert Foothills Theater does not provide medical insurance for any participant in any program offered. I, the Parent or Guardian of this camper as registered, a minor, do hereby authorize the directors and teachers of Desert Foothills Theater as agents to consent to medical emergency treatment. I hereby release Desert Foothills Theater and its Board of Directors from any and all claims from personal injuries.

As the parent and/or legal guardian of the camper registered here, I hereby give permission for my student to be given emergency treatment as needed by members of Desert Foothills Theater (DFT). I give permission for the student to be transported by ambulance to an emergency center for treatment. In the event that I, my student’s listed emergency contact, or my preferred physician cannot be contacted, I consent to medical, surgical and hospital care treatment and procedures to be performed for my child by a licensed physician or hospital when deemed immediately necessary or advisable by a physician to safeguard my child’s health. I agree that I will not hold DFT or any member of its staff liable for damages, injuries or losses during the student’s participation with the DFT education programs.

I also consent that camper’s photo or video may be taken and used for any purpose deemed necessary to promote Desert Foothills Theater education program without compensation.

GENERAL MEDICAL RELEASE: I have read, understand, and agree with this document.*

Yes

GENERAL PUBLICITY RELEASE: I have read, understand, and agree with this document.*

Yes

CANCELLATION POLICY: 100% refundable up to two weeks before camp. 50% refundable during the two weeks before the first day of camp. No refund once camp has started. ALL REFUNDS SUBJECT TO A $25 CARD PROCESSING FEE.

I have read and understand the cancellation and refund policy.*

Yes

Camp Registration Fee*

Holland Center Beauty and the Beast Summer Camp$295.00

Total $0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please verify that you are human*

Camper's Information

Parent/Guardian Information

Child Pick Up Authorization at The Holland Center, N. Scottsdale

Special Accommodations