KPAC Playhouse Theatre Summer Break Camp -Registration Form
All forms will be reviewed by the KPAC manager prior to enrollment. Filling out a registration form does not guarantee a space in care. Camp is for Ages: 12 to 18 years old. *will allow mature 10 & 11 year old's Camp week one: July 6 - 10 10 a.m. to 4 p.m. daily Camp Week Two: July 13-17 10 a.m. to 4 p.m. Daily Performances Friday, July 10 @ 2:15 p.m. & Friday July 17 @ 2:15 p.m. Please note that Week Three registration is thru the City of Dawson Creek Recreation Summer Camps, Stage Craft: https://www.dawsoncreek.ca/parks-recreation/recreation-programs/camps/
KPAC Summer Break Camp is $225 + a registration fee per student, per week. Additional fees if you are not a current KPAC member.
Participants will have the opportunity to learn the fundamentals of a theatre, Week One will perform Shakespeare's Hamlet & Week Two will perform Aesop's Fables; including hands-on experience in set design and costuming.
Registering for:
Week One, July 6-10
Week Two, July 13-17 *note changed to earlier in July from August
Both Weeks
Participant Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Information
Name
*
First Name
Last Name
Relationship to participant
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Photo/Video Waiver - I the undersigned, authorize the KPAC and KCCC to use any photo/video of my child taken during class time to be used to market and promote the KPAC or KCCC in printed or other media publications, including but not limited to Facebook, City of Dawson Creek Leisure Guide, brochures and/or websites.
*
Yes
No
Code of Conduct; I the undersigned, agree to follow the KPAC Code of Conduct which will be received upon registration and must be signed & handed in on day one
Yes
No
Does your child have any allergies, medical conditions, or support needs we need to be aware of?
*
Yes
No
If so, please describe
Required Consent
Please check boxes to confirm you have read, understand, and consent to the statements below.
Parent's Commitment - I have discussed with my child and confirm they agree to participate in the Spring Break Theatre Camp Program and agree to follow safety instructions. I am aware that failure to follow safety rules or any inappropriate behaviour towards staff or students can result in removal of my child's participation in Spring Break Camp.
*
Yes
No
Release of Liability - I release and discharge any and all rights and claims for damages of suit or action that my child may have at any time against the Kiwanis Arts Society Centre or the Kiwanis Child Care Centre, along with all employees and for any and all injuries suffered by my child as a result of participating in our Spring Break Camp. KPAC/KCCC is not responsible for any lost or damaged personal items.
*
Yes
No
I, the undersigned, hereby certify that all the information provided is true and correct to the best of my knowledge and belief.
*
Submit
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