MagikTheatreCampRegistration

SCHOLARSHIP FORM Magik Theatre Summer Camp

Please submit the following form to apply for for a camp scholarship. Scholarships are limited and awarded on a case-by-case basis based on availability of funds.
For "Magik Theatre Goes to Broadway," please select which camp week(s) you are interested in:
Please select your camper's age group:
For "The Percy Jackson Musical Theatre Experience," please select which camp week(s) you are interested in:
Please select your camper's age group:
Camper Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
What are your camper's preferred pro-nouns?
Grade in the Fall*
Please select camper's t-shirt size
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information #1
Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
E-mail*
example@example.com
Parent/Guardian Information #2
Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
E-mail
example@example.com
Emergency Contact Information

(other than parent/guardian information)
Emergency Contact*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Please indicate in the space below, all persons authorized to pick up your camper, including guardians and emergency contacts.
Authorized Pick Up #1:   First Name*   Last Name*
Authorized Pick Up #2:   First Name   Last Name
Authorized Pick Up #3:   First Name   Last Name
Medical Information
Please list any medical conditions, medications, allergies, special needs, recent injuries, or behavioral accommodations/strategies we should know about to help your camper have the most successful and positive experience possible.*

Photo Release

Magik Theatre documents all of the productions and programs provided by the Education Department. These services include photographs, videos and/or audio recordings that will be used for archival and promotional purposes.

YES - Magik Theatre HAS MY PERMISSION to use the photographs, videos and/or audio recordings taken of my child while participating in programs at Magik Theatre.

NO - Magik Theatre DOES NOT have my permission to use the photographs, videos and/or audio recordings taken of my child while participating in programs at Magik Theatre.
Please select the permissions from the dropdown menu below: *
Informed Consent & Acknowledgement
Camper's Name*

First NameLast Name
Parent's Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

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Scholarship Interest Reponses
Why you are interested in a scholarship? *
How much would you be able to contribute for the registration?*
The education department will contact awardees within 7-10 business days to confirm availability and complete the registration process.
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SCHOLARSHIP FORM Magik Theatre Summer Camp