Summer Camp Registration

Summer Camp Registration

Our summer camp will run from June 5 - June 10th at Prairie Players Civic Theatre in Galesburg, Illinois. Our production for the camp will be Rapunzel!
A full schedule will be handed out on the first day of camp, but here is a rough overview:

Young Actors (entering 1st grade - 7 years old) will meet from 10am-12pm Monday-Thursday and 10am-1pm on Friday.

Junior Actors and Assistant Directors (ages 8 and up) will meet from 10am-2pm Monday-Friday with a 15-minute break each day.
Camper Information

Please provide information about the summer camp participant.
Name*

First NameLast Name
Pronunciation
If there is a specific pronunciation for the camper's first name, please include that here.
Pronouns*

he/him/hisshe/her/hersthey/them/theirsOther
Age*

Under 18 years old18 years old
Registration Options*
prevnext( X )
Young ActorFor campers entering 1st grade through 7 years old. Guaranteed a role in the play!
$ Free



Junior ActorFor campers ages 8 - 18 years old. Guaranteed a role in the play!
$ Free



Assitant DirectorFor campers ages 12-18. a leadership opportunity
$ Free
Parent or Guardian Information

As the camper is under 18, we need some information from the parent or guardian.
Guardian Name*

First NameLast Name
Guardian Email address*
example@example.com
Guardian phone number*
Please enter a valid phone number.
Who will serve as the emergency contact while the camper is at camp?*

I willAnother adult
Consent

I affirm that I am the parent or legal guardian of {campername}.

I give permission for {campername:first} to participate in the Prairie Players Civic Theatre summer camp program, produced in cooperation with Missoula Children's Theater.

In the event that a leader of the summer camp identifies an emergency situation, I give permission for them to make a decision about whether to call an ambulance or notify an emergency contact, understanding that I will be notified either way.
Typed Name equivalent of Signature of parent or legal guardian. *
Signature of parent or legal guardian

Clear
Contact Information
Does the camper have their own email address or phone number, separate from their parent or legal guardian?*

Email addressPhone numberNone of the above
Camper's Email address*
example@example.com
Camper's Phone number*
Please enter a valid phone number.
Emergency Information
Name of Emergency Contact*

First NameLast Name
Phone Number of Emergency Contact*
Please enter a valid phone number.
Does the camper have any allergies or medical conditions of which the camp leaders should be aware? *
Primary Email Contact Info
example@example.com
From Name
Should be Empty:

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Summer Camp Registration

Camper Information

Parent or Guardian Information

Contact Information

Emergency Information