YouthLab 2025 Registration

YouthLab Summer Camp 2025

Each camper will require their own registration.
Camper's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Age*
Grade in the Fall
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian E-mail*
Mobile Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Emergency Contact*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
Physician's Name*

First NameLast Name
Physician's Phone Number*

Area CodePhone Number
List all known medical conditions (including allergies to food or medications
List any and all over-the-counter and/or prescription drugs taken regularly
Medical Insurance
Insurance Policy Number
Medical information is needed in the event of an emergency and the parent/guardian cannot be reached. Marking the selection below will act as your signature & authorization for emergency medical care

I authorize such diagnostic, medical, and/or surgical treatment of my child as may be considered necessary or appropriate under the circumstances for the treatment of any illness or injury, by licensed emergency medical professionals.
I give permission and consent for my child (listed on this application) to allow photographs to be taken during YouthLab camp session activities. I further give permission and consent that any such photographs may be published and used by TheatreLab Dayton to illustrate and promote the camp experience. I release TheatreLab Dayton / Dare 2 Defy Productions from all claims, demands, and liabilities whatsoever in connection with above. Marking the selection below will act as your signature & authorization for show-related photographs.

I authorize TheatreLab Dayton to utilize photos of my child for promotional or marketing materials.
How did you hear about our Summer Camp?

My Products

Future Stars Camp - Ages 8-14$215.00

1 week - July 21-25, Mon-Fri 9a-3p

Quantity

Camp Scholarship Donation$1.00

Donations go toward YouthLab Scholarship

Quantity

Enter coupon

Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

YouthLab Summer Camp 2025