Teen Performance Summer Camp Application
Disney's Youth Version Anastasia June 19 - June 30 from 9 AM - noon Performance June 30th at Paul J. Ciener Botanical Garden Cost: $250
Name of Camper
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Prefer Not to Say
Email of Camper
example@example.com
Phone Number
Mobile Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What performance experience do you have?
Please explain on the field provided
Camper T-shirt size (shirts are in adult sizes)
XXS
XS
S
M
L
XL
XXL
XXXL
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Name of Second Camper
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Prefer Not to Say
Email of Second Camper
example@example.com
Phone Number
Mobile Phone Number
Address (If different from that of first camper)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What performance experience do you have?
Please explain on the field provided
Camper T-shirt size (shirts are in adult sizes)
XXS
XS
S
M
L
XL
XXL
XXXL
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Medical Information
Does the camper have allergies including asthma?
Please explain on the field provided
Will the camper need any medications?
Please provide the details, the name of the medication and period of intake
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Contact Information in Case of Emergency
Name of Emergency Contact
First Name
Last Name
Emergency Contact Number
-
Area Code
Phone Number
Email of Emergency Contact
Relation to camper
Alternate Emergency Contact Name
First Name
Last Name
Alternate Emergency Contact Number
-
Area Code
Phone Number
Email of Alternate Contact
Relation to camper
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Payment
Total amount for chosen camps
Payment Amount
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next
( X )
USD
Description
Signature of applicant or guardian representative
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Submit
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