FCTC Theater Camp 2023

Theatre Summer Camp Registration
The Fairfax Community Theatre Company and Fairfax Parks & Recreation are excited to team up to bring an exciting week of theatre camp for youth grades 5th - 8th!

This year's production will be the classic "Treasure Island"

Your children will enhance their performance skills through fun group exercises and practice with experienced performers from the Fairfax Community Theatre Company. They will learn about the value of working together to create a memorable production and finding their voice along the way!

This camp will be located at the Fairfax Community Center and run from 9AM to 4PM every week day during the week of July 31st. Additionally, your camper will be expected to be involved with the final performances at the end of the week on Friday evening, for families and community members to enjoy!

Cost is $150 for the week. After registration, please mail or drop off your check or cash to the Town of Fairfax, 12 Buck Hollow Road, Fairfax, VT 05454

Please submit only one application form for each child you register. If there is an issue with the form you submitted, please contact Danielle at recreation@fairfax-vt.gov instead of submitting a duplicate form.
Child Information
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
What Grade is your Child entering in the fall of 2023?*
Child's Gender*

Prefer not to sayMaleFemaleOther
Please list all known allergies your child has*
Please list any dietary restrictions your child has*
Please list any medications your child takes*
Does your child require modifications to be made to the camp or accommodations to participate? If so, briefly describe and we will be in touch.
Contact Information
Primary Parent or Guardian Name*

First NameLast Name
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
Primary Email*
example@example.com
Primary Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (Cannot be the same as Primary)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contacts Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional person who has permission to pick up this child

First NameLast Name
Additional person's phone number
Please enter a valid phone number.
Permissions
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY, AND PARENTAL CONSENT AGREEMENT

I hereby release and discharge the Town of Fairfax and the Fairfax Community Theatre Company, their agents, employees, staff members, directors, and volunteers from any claims, responsibilities or liabilities for injuries or harm incurred as a result of my child's involvement as a participant in summer camps through the Town of Fairfax and Fairfax Community Theatre Company.

I accept that allowing my child to participate in educational, instructional or recreation activities includes risks.
Signature*

Clear
Date (Today's Date)*

MonthDayYear
Date
MEDICAL RELEASE

I hereby grant consent to any and all health care providers designated by the Town of Fairfax and Fairfax Community Theatre Company to provide my child with any necessary medical care as a result of any injury or illness. This consent includes First Aid and CPR administered by staff of the Town of Fairfax or Fairfax Community Theatre Company and transportation by Fairfax Rescue to the hospital.

If an emergency should arise, I understand that a thorough effort will be made to contact me or or an emergency contact before action is taken, but I agree to accept any expense associated with such an emergency if it is not possible to contact me in advance of treatment.
Signature*

Clear
Date (Today's Date)*

MonthDayYear
Date
ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO COVID-19

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child and I may be exposed to or infected with COVID-19 by attending this camp and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at this camp may result from the actions, omissions, or negligence of myself and others, including, but not limited to, camp employees, volunteers, program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child or myself (including but not limited to, personal injury, disability and death) illness, damage, loss, claim, liability, or expense of any kind, that I or my child may experience or incur in connection with my child's attendance at the Town of Fairfax Summer Camp and its programming (“Claims”).

On my behalf and on behalf of my child I hereby release, covenant not to sue, discharge and hold harmless the Town of Fairfax and the Fairfax Community Theatre Company, their employees, agents, and representatives, of and from the Claims including all liabilities, claims, actions, damages, costs or expensive of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Town, its employees, agents and representatives, whether a COVID-19 infection occurs before, during or after participation in any Fairfax Parks and Recreation program.
Signature*

Clear
Date (Today's Date)*

MonthDayYear
Date
PICTURE / VIDEO WAIVER

I give my consent and authorization for my child to be photographed while participating in this Fairfax Summer Camp. By willingly signing below, I grant the Town of Fairfax and Fairfax Community Theatre Company permission to use photographs and videos taken during these summer camps. Pictures and videos may be used for up to 10 years after the date they were captured.
Signature

Clear
Date (Today's Date)

MonthDayYear
Date
PERMISSION TO ATTEND CAMP

I, Parent / Guardian of the participant, authorize him / her to attend the 2021 Fairfax Theatre Camp.

I give permission for my child to go on trips by foot while accompanied by camp staff members away from the main camp location to BFA Fairfax and the Fairfax Community Park.

I give permission for my child to watch "G" or "PG" rated movies with staff members present during showings.

I give permission for the people I have listed to pick up my child. I understand that these people will be asked for identification if not recognized by camp staff members. I additionally acknowledge that my child will not be released to any person other than those I have listed.
Signature*

Clear
Date (Today's Date)*

MonthDayYear
Date
Additional Notes

Please enter any additional information about your child you think we should know
Notes or Comments
Should be Empty:

Theatre Summer Camp Registration

Child Information

Contact Information

Permissions

Additional Notes