2024 Spring Camp Registration Form

Spring Break Camp Registration Form
Spring Break Music Theater Workshop in Collaboration with Lovewell Institute for the Creative Arts
Mon., March, 25 – Fri., March, 29 2024
9 am – 4 pm
Ages 11 - 16

Location:
Hollywood Central Performing Arts Center
1770 Monroe St, Hollywood

Performance: March 29, 2024 | 7 pm

The spring, student performers will write every line and lyric, led and directed by the skilled staff who have crafted the art of the Lovewell method. The Lovewell Institute provides interdisciplinary arts-based programs that empower people from all cultures and economic backgrounds to find their authentic voice through the collaborative creation and performance of an original work of theater.

Campers must provide their own non-perishable lunch and snacks.
Parent/Guardian*
Address*

Street Address

Apt./Unit No.

CityState

Zip Code
Phone Number*

Area CodePhone Number
Alternate Phone

Area CodePhone Number
Email*
example@example.com

Participant 1
Participant Name *
Age*
School*
Is your child covered under health insurance?*

YesNo
If so, by what company?*

Participant 2
Participant Name
Age
School
Is your child covered under health insurance?

YesNo
If so, by what company?

Participant 3
Participant Name
Age
School
Is your child covered under health insurance?

YesNo
If so, by what company?

Participant 4
Participant Name
Age
School
Is your child covered under health insurance?

YesNo
If so, by what company?

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Agreement

Tuition must be paid in advance. Participant is registered only upon receipt of registration form and full payment. All returned checks and denied credit cards will incur a $50 service fee. We cannot prorate sessions or issue refunds unless sessions are cancelled by the Art and Culture Center/Hollywood.

As the parent or legal guardian of the aforementioned child, I certify that I hold harmless and release the Art and Culture Center/Hollywood, its employees, and agents from any liability, claim, right of action, of any kind or nature which I, my child, or legal representative may have as a result of injury, illness, or damage. I authorize the Art and Culture Center to seek urgent medical care in the event of an emergency.

I hereby allow the Art and Culture Center/Hollywood to take photographs or videotape of me/my child during participation in its programs. The photos or video may be used for the sole purpose of promoting the Art and Culture Center/Hollywood.

I have read and understand all of the above
Signature*

Clear
Date*

MonthDayYear
Date

product

Member Spring Break Camp | March, 25 – March, 29 2024$300.00

Full payment is required to secure your spot in camp.

Quantity

product

Non-Member Spring Break Camp | March, 25 – March, 29 2024$325.00

Full payment is required to secure your spot in camp.

Quantity

Become A Member!$75.00

Purchase a Family Membership and receive a discount for this and future programs.

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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