Little Mermaid Jr Detailed Registration Form

Summer Camp Registration

July 14-27 10-3 with shows at 6pm final Friday and 2pm Saturday
Actor's Name

First NameLast Name
Birth Date

MonthDayYear
Grade entering
Preferred pronouns
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the actor have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Pegasus Playhouse during the selected camp. In exchange for the acceptance of said child’s candidacy by Pegasus Playhouse ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Pegasus Playhouse . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Pegasus Playhouse . including all teachesr and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Summer Camp Registration