Jr. Counselor Application Form - Performing Arts Workshops

Student's Full Name*

First Name

Last Name

Home Address*

City*

State*

Zip Code*

Student’s Cell/Home Phone Number*

Parent E-Mail Address*

Birthdate*

Age*

Gender*

Mom/Guardian's Full Name *

Dad/Guardian's Full Name

Cell Phone (Mom)*

Cell Phone (Dad)

Day Phone (Mom)*

Day Phone (Dad)

*Emergency Contact is an adult for emergency use only -- when a parent/guardian cannot be reached.

Emergency Contact Name*

Emergency Contact Phone*

Pediatrician Name*

Pediatrician Phone*

Describe your experience in the arts*

Describe why you would like to be a PAW Jr. Counselor*

List names of school/summer performing arts programs you have attended*

Name of your school*

Current grade level*

Number of years experience in the Arts*

Current grade point average*

Choose Your PAW Tuition Discount

Other PAW Discount or Coupon ID Number

Optional Camp T-Shirt

Buy it now with registration for only $15. (Available at camp for $20)

I have read, understand and agree to the information regarding dates, rules and company policies:*

I agree

1. All registration, camp hours, attendance, casting and refund policies.
2. I understand the Jr. Counselors must be 15 or 16 years at time of session. PAW reserves the right to offer up to 3 spaces per session, per camp site.
3. Allow PAW to use their selected nurse, physician or call 911 in the event of an emergency and I cannot be reached. I must disclose to PAW any special needs or allergies my child may have and agree to provide arrangements as required by PAW. Failure to do so may result in the termination of camp participation and/or removal from camp.
4. Allow my child to participate in any promotional pictures and videos from the camp.
5. Cancellation of any session has a $95.00 non-refundable registration fee.
6. Deadline for refund requests is June 1st, 2019.
7. I understand there are no cash refunds if my child is absent due to illness, withdraws early or is removed from camp due to behavior or discipline problems.
8. PAW reserves the right to substitute activities as necessary.
9. Space is limited - register early to ensure a spot. A child may join a session after it has begun if space is available. Parents can call the PAW office to confirm availability when signing up on or after the start date of a session or speak with the on-site camp director. PAW reserves the right to cancel a camp session if the enrollment is insufficient. In the event of a cancelled session, PAW will refund in full or apply tuition to another session.
10. On behalf of my child and for myself, I knowingly assume all risks arising from participation in activities related to camp programming. I certify that I have legal authority to sign this release/waiver of liability, and sign it without duress or coercion.

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

[ Click Here For Bike/Walk Form ] If YES, complete and return the following form via email: performingartsla@aol.com

Child Will Be Picked Up By*

[Click Here For Pick Up Form] If other than parent, complete and return the following form via email: performingartsla@aol.com

Billing Information

Card Holder’s Full Name (as it appears on card)*

Card Holder's Phone*

Address On Card*

City*

State*

Zip*

Debit/Credit Card Info

Type of Credit Card*

Card Number*

Exp. Date*

CV2# (security code)*