Gallery Theatre Summer Performing Arts Camp Application

Camp Dates: June 16-July 31st with Special End-of-Camp Performance
Camp Location: Gallery Theatre, 115 W. Main Street, Ahoskie, NC 27910
Camp Hours: 9 AM-3 PM, Mon-Fri; Aftercare available from 3 PM-5 PM
Ages: 7 & up
Camp Fee: $25 per week; An additional $40 per week for aftercare ($8 per day) Weekly payments can be made or Full amount. Multiple child discount of $5 off per child
Information

Youth & Parent/Guardian Information
Youth's Name

First NameLast Name
Date of Birth
Grade Level (as of Fall 2025)
T-Shirt Size

Youth SYouth MYouth LAdult SAdult MAdult LAdult XL
Parent's Name

First NameLast Name
Phone Number
Email Address
example@example.com
Mailing Address
Emergency Contact Name
Emergency Contact Phone Number
Medical Information
Does the participant have any allergies?

NoYes
If yes, please explain.
Is the participant currently taking any medications that are to be taken during camp hours?

NoYes
If yes, please explain.
Media Release & Liability Waiver
I grant permission for my child’s photo/video to be used in promotional materials for Gallery Theatre.

NoYes
I understand that participation in the Summer Performing Arts Camp involves physical activities, and I release Gallery Theatre from any liability for injuries.

NoYes
A non-refundable deposit of $30 is required to secure your child’s spot. Payment for the first week of camp is due no later than Tuesday, June 10, 2025. Full payment can be made in advance at anytime; however, if paying weekly, payments are due every Tuesday of the week prior.

Parent Orientation will be held on Sunday, June 1, 2025 at 4pm. Please plan to attend. A lot of information will be shared concerning our camp policies & procedures, codes of conduct, and what to expect from our camp. If unable to attend in person, there is an online option. Parent Orientation is mandatory for your child's participation in camp and must be completed before the first day of camp.

We look forward to an exciting summer of creativity and performance!
Parent/Guardian Signature
Signature

Clear
Date

MonthDayYear
Date
Camp Registration Fee

https://www.paypal.com/ncp/payment/7JP62L3TZGVZU
Weekly Camp Fee

https://www.paypal.com/ncp/payment/KPKUQDA3XHANS
Total Camp Fee (Paid In Full)

https://www.paypal.com/ncp/payment/6GPFX7QQMZTWQ
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Information

Medical Information

Media Release & Liability Waiver

Parent/Guardian Signature

Camp Registration Fee

Weekly Camp Fee

Total Camp Fee (Paid In Full)