Camp Shine 2024 Registration Form

Camp Shine 2024 Registration Form

This summer camp will provide middle and high school students an opportunity to participate in a range of creative exercises spanning from drama and musical theatre to songwriting and art. Classes will be led by the professional instructors at Barclay Performing Arts. Camp will conclude with an exciting finale performance, to be celebrated alongside family and friends.
WHEN & WHERE

JUNE 17 - JULY 3

MONDAY - FRIDAY 9:00 AM - 2:00 PM

BYOL (Bring your own lunch)

FINALE CELEBRATION

Wednesday, July 3rd, 4 - 6 PM

LOCATION

BARCLAY Performing Arts

9050 Kimberly Blvd #65, Boca Raton, FL 33434
Participant Name

First NameLast Name
Birth date

MonthDayYear
Date
Check one or more options that reflect your gender
Ethnicity
What grade level you will be entering for the 2024-2025 calendar year?
What school will you be attending?
Will you require transportation to and from Coral Springs Middle School to BARCLAY Performing Arts
Participant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Participant Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact's Name

First NameLast Name
Relationship
Emergency Contact's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
T-Shirt Size
Do you have any allegeries, food restrictions, medical conditions or disabilities? If yes, please describe.
I agree to attend all dates as listed above including the final performance on 7/3. Please list and explain any attendance conflicts with dates
Type "Yes" if you agree
Is there anything else you would like us to be aware of or take into consideration?
How did you hear about our camp?
RELEASE STATEMENT:I understand that the SHINE MSD Summer Camp is held at BARCLAY Performing Arts, and I agree to abide by all its policies. I give permission to use photographs & videos of my child or me for any and all promotional purposes.I/We as an individual or as a parent or guardian of the participants named herein, assume all risk and hazards incidental to the activities and release from responsibility and agree to indemnify and hold harmless SHINE MSD, their officers, directors, independent contractors, volunteers, on site staff and all employees for any illness and injury to me or my children or family members occurring during his/her/our participation in any activities or use of any facilities at/or conducted by SHINE MSD. Bullying or harassment of any form will result in a dismissal from the program. Signing this document means you have read and agree to the terms listed herein.
Signature
Attendance is limited. Once your application is submitted Shine MSD will email you with confirmation of your registration. Please reach out to Mkochan@shinemsd.org with any questions.
ShineMSD has provided over 50 free workshops and camps to students across south Florida. Please consider donating to our organization and helping us continue creating impacts through creative art therapy.

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