IN-PERSON SUMMER CAMP REGISTRATION FORM

IN-PERSON SUMMER CAMP REGISTRATION 2022

Child's Name*

First Name

*

Last Name

Home Address*

Street

*

City

*

State

*

Zip Code

Child's Birthday*

Age At The Time Of Camp*

Child's Gender*

Parent 1*

First Name

*

Last Name

Cell Phone Number*

Day Phone Number

EMAIL Address of Parent Enrolling Camper*

Parent 2

First Name

Last Name

Cell Phone Number

Day Phone Number

If your child is enrolling in Stage FX Makeup, please select Your Child's Ben Nye Makeup Kit Complexion:

EMERGENCY CONTACT INFORMATION

*Emergency Contact is an adult (other than the parent/guardian) who can be called in the event of an emergency, when a parent/guardian cannot be reached. PAW will always FIRST attempt to reach the parent/guardian. Do not list parent/guardian here.

Emergency Contact Person*

Full Name

Cell Phone Number*

Relation To Child*

Pediatrician Name*

Full Name

Phone Number*

CHILD PICK-UP AUTHORIZATIONS

Child will be picked up by:*

If other than Parent, complete and return the following form via email: performingartsla@aol.com.

Click Here For: Pickup Authorization Note

I give permission for my child to walk/bike home from camp daily:*

If YES, complete and return the following form via email: performingartsla@aol.com.

Click Here For: Walk/Bike Authorization Note

BUILD YOUR SUMMER SCHEDULE

TWO WEEK CAMP SELECTIONS: