CAMP REGISTRATION INFORMATION 2025

ACTIN' UP! THEATER CAMP
2025 CAMP REGISTRATION FORM
General Information
Camper Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age (as of July 1, 2025)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School
Pediatrician
Please list all allergies

PARENT/GUARDIAN INFORMATION & PICK-UP AUTHORIZATION
Parent/Guardian Name

First NameLast Name
Address (if different from Child)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email Address
(Please list 2 contacts to call if parent / guardian cannot be reached
Name
Relation
Phone Number
Please enter a valid phone number.
Name
Relation
Phone Number
Please enter a valid phone number.
Please provide us with information about your campers experience with the arts or anything else you would like to share!

PAYMENT INFORMATION
A non-refundable $100 deposit is due with this application. Please include your campers name with the payment.

The payment should be made to the following account:

Acct. Name: Monique Bridgewater

Acct. No.: BNTB0600247790034

*THE DEPOSIT WILL BE DEDUCTED FROM THE FINAL AMOUNT DUE.

FINAL PAYMENT DUE JUNE 1ST, 2025.
Total Due:
Parent/Guardian Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty: