Day Camp Registration Form

Pure Imagination Summer Camp Registration Form

CAMP IS FOR RISING 6TH - 9TH GRADERS
Camper's Information

Personal & Health & Contact
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
Age (at time of camp)*
Grade (entering this fall)*
T-shirt Size:*

Youth SmallAdult SmaillYouth MediumAdult MediumYouth LargeAdult Large
List Any Allergies and Dietary Restrictions*
Medications & Frequency*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Information

(All correspondence and and invoices will be sent to this person)
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*

Area CodePhone Number
Work Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Camper*
Emergency Contacts and Authorized Pick Up Persons*
Program Information

Program & Transportation & Payment
Terms & Conditions
Pure Imagination Camp Registrations*
Categories:All

All
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July 27th - August 7th -Full 2 Week Camp Theatre Skill & Pure Imagination Performance Intensive$500.00

August 3rd-7th Pure Imagination Performance Intensive$275.00

July 27th - 31st Pure Imagination Theatre Skill Camp$275.00

Total $0.00
Signature

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Date

MonthDayYear
Date
Payment Methods

Fastlane Checkout

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

Contact Info

Payment Info
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Pure Imagination Summer Camp Registration Form