Summer Camp Detailed Registration Form

Space Coast Performing Arts Summer Day Camp Registration

Join Space Coast Performing Arts at its Satellite Beach or West Melbourne locations for performance-based camps, taught by our expert staff.
Student Information
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade (as of Fall 2025)*
Student email (if applicable)
Are you a new or returning student to any of Space Coast Performing Arts programs?*

NewReturning
If you are new, how did you hear about us?

Internet searchA friendHenegar program adSocial mediaCame to a show/event
IF NEW: Please fill in your address for our records.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Camp(s) you are enrolling in for Summer of 2025 (check all that apply):*

July 7 - July 11, West Melbourne: Rock band camp (grades 5 to 12), Mon to Fri, 9am to 3pm; Student performance Friday at 2 p.m. Camp held at Universalist Unitarian Church, 2185 Meadowlane Ave. West Melbourne.July 14 - July 18, Satellite Beach: Show Choir Camp (grades 5 to 12), Mon to Fri, 9am to 3pm, Student performance Friday at 2pm; Camp held at Trinity Wellsprings Beach House, 638 South Patrick Drive, Satellite Beach
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Additional Parent/Guardian Information
Name

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

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Does this student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is there anything else we should know about this student that will help us ensure their health, safety or mental well being during the camp?
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Space Coast Performing Arts during the selected camp. In exchange for the acceptance of said child’s candidacy by Space Coast Performing Arts, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Space Coast Performing Arts, 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 Space Coast Performing Arts. including all staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
I hold harmless Space Coast Performing Arts for the statements immediately above.*

Agree
Medical Release and Authorization

As Parent and/or Guardian of the named participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Space Coast Performing Arts and its affiliates including staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
I agree to the medical release and authorization listed directly above.*

Agree
Summer Camp Payments*
prevnext( X )
Elementary Musical Theatre CampFour days of camp
$200.00 Quantity



All Other CampsFive days of camp for improv, rock band and show choir.
$250.00 Quantity



Step Up for Students If you are already approved by the Step Up program for part-time tutoring, please email katie@beachsideperformingarts.com to complete your registration
$ Free Quantity



Total

$0.00
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Space Coast Performing Arts Summer Day Camp Registration

Student Information