Summer Camp 2026 Registration Form
Caregiver Name
*
First Name
Last Name
Caregiver Email
*
example@example.com
Caregiver Phone Number
*
Please enter a valid phone number.
Student 1- Name
*
First Name
Last Name
Student 1 - Date of Birth
*
-
Month
-
Day
Year
Date
Student 1 - Rising Grade Level (Fall 2026)
*
What program(s) are you registering Student 1 for?
*
Does your student (student 1) have any allergies or other health concerns that our education staff should be aware of?
*
Yes (please list below)
No
If yes, please list them below:
Does your student (student 1) have any communication, mobility, or other needs that you would like us to know about?
*
Yes (please list below)
No
If yes, please list them below:
Anything else you would like for us to know about your student (student 1)?
Student 2 - Name
First Name
Last Name
Student 2 -Date of Birth
-
Month
-
Day
Year
Date
Student 2 - Rising Grade Level (Fall 2026)
What program(s) are you registering Student 2 for?
Does your student (student 2) have any allergies or other health concerns that our education staff should be aware of?
Yes (please list below)
No
If yes, please list them below:
Does your student (student 2) have any communication, mobility, or other needs that you would like us to know about?
Yes (please list below)
No
If yes, please list them below:
Anything else you would like for us to know about your student (student 2)?
I allow Portland Stage to use my child's photo, video or audio:
*
Yes, can use in marketing
No, do not use in marketing
Release Information
I understand these activities may include certain risks including, but in no way limited to: (1) moderate & severe personal injury, (2) property damage, (3) disability, (4) death, & (5) sickness or disease including, without limitation, COVID-19. I specifically release Education, its owners, directors, employees, & volunteers from any claim of any kind arising from my student’s participation in the Education program.
Initial
*
Behavior Policy
We are committed to working with students, parents, and guardians to ensure everyone has a positive experience at Portland Stage. Each student is expected to engage with others in a safe and respectful manner to help everyone achieve the best possible experience. If our Teaching Artists or Staff have a concern regarding a camper’s behavior, our policy is: 1. Teachers/Staff will redirect the student to more appropriate behavior. 2. If inappropriate behavior continues, the student will be reminded of the camp expectations and behavior guidelines. Together, the student & teachers/staff will decide on action steps to correct the behavior. 3. If disruptive behavior continues and/or is affecting the safety or well-being of others, Education staff will contact the parents or guardians. 4. If inappropriate behavior continues, as a final action step, the student may be dismissed from camp. (Please note – Student fees are non-refundable if a student is sent home for disciplinary reasons). I have read and agree to the Behavioral Dismissal policy. If you have any questions, please contact education@portlandstage.org
Initial
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Signature
*
Date
*
-
Month
-
Day
Year
Date
PLEASE NOTE: This registration is not complete until the payment is completed on next window.
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