Registration Form

REGISTRATION FORM

SUMMER CAMP 2024
CHILD'S INFORMATION
Student Name*

First NameLast Name
Gender*
Age*
What is your child's experience?

ActingDancingSingingTechnical Stage
Parent Information
Parent's Full Name*
E-mail*
Phone Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HEALTH & MEDICAL INFORMATION
Emergency Contact Name*
Emergency Contact Phone Number
Health/Allergies
Please state any health issues
DISCLAIMERS
By participating in our program, you grant us permission to use photos and videos taken during the activities for promotional purposes. Your privacy is important to us, and we will not disclose personal information alongside the images. If you have concerns, kindly contact*

I acknowledge and agree to the terms of the media release disclaimer
Participants acknowledge that engaging in rehearsals and performance for the Brockville Theatre Camp involves physical activity and inherent risks. Our organization is not liable for any injuries sustained during the program.*

I acknowledge and agree to the terms of the injury disclaimer.
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