Jr. Counselor Application Form – Performing Arts Workshops

PAW JR. COUNSELOR APPLICATION 2022

Student's Full Name*

First Name

Last Name

Home Address*

City*

State*

Zip Code*

Birthdate*

Age at Time of Camp*

Gender*

Parent 1 Full Name*

First Name

Last Name

Parent 1 Cell/Home Phone*

Parent 1 Work/Day Phone

Parent 2 Full Name*

First Name

Last Name

Parent 2 Cell/Home Phone*

Parent 2 Work/Day Phone

Parent's Email Address*

Student's Cell Phone*

Student's Email Address*

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 Name*

Emergency Contact Phone*

Pediatrician Name*

Pediatrician Phone*

STUDENT PICK-UP AUTHORIZATIONS

Jr. Counselor will be picked up by:*

If other than Parent will pick up, 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

Select Camp Location*

Select Camp Activity*

Choose Your Session(s)*

WEST SIDE STORY: June 13 to June 24 - $325

FROZEN: June 27 to July 8 - $292 (Camp is closed July 4th!)

HIP HOP HAMILTON: July 11 to July 22 - $325

RAPUNZEL: July 25 to Aug 5 - $325

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*

GET A PAW T-SHIRT 🙂

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

ORDER A PAW THEATERGRAM 🙂

A keepsake TheaterGram with your loving words and congratulations for an endeavor well done will be hand delivered to your Jr. Counselor by PAW teachers backstage before the show. Just $10

(A truly wonderful way to help support PAW’s scholarship program)

PAW TheaterGram

No

Yes

CHOOSE YOUR CAMP DISCOUNT

Only ONE discount, gift certificate, or coupon may be applied per registration. The amount will be deducted from your total when PAW manually processes your credit/debit card.

Other PAW Discount or Coupon ID Number

BILLING INFORMATION

Payment Method (Please Select One):

Option 1: PRE-PAID PAW CREDIT/GIFT CERTIFICATE

Please apply my credit from my pre-paid tuition to the total for this in-person summer camp registration. Any remaining balance will be applied to my future sessions. If the total of my camp selections exceed my credit on file, I authorize PAW to charge my card on file for the amount due. Prior to charging any balance, PAW will email me the amount due for my review.

To Authorize, Initial Here

Option 2: CREDIT/DEBIT CARD

Cardholder’s Name (as it appears on the card)

Cardholder’s Phone Number

Cardholder’s Billing Address

Street

City

State

Zip

Credit/Debit Card Information

Type Of Card (VISA, MC, AMEX, etc.)

16-Digit Card Number

Expiration Date (mm/yy)

CV2# (Security Code)

CAMP POLICIES

1. I have read, understood and agree to all camp registration, 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 May 1st, 2022.
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 issues.
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 due to low enrollment, PAW will refund in full or apply tuition to another session of my choosing.
10. I understand that Jr. Counselors need to arrive at camp each day between 8:00am and 8:30am and are asked to remain present until the camp day ends at 3:00pm. Unless ill, Jr. Counselors are asked to attend camp each day of the session(s) they are registered for.
11. I understand Jr. Counselors are not permitted to leave campus during camp hours to buy snacks/food/lunch and are required to BRING food each day including a snack for mid-morning break, a packed lunch, as well as a water bottle in order to stay hydrated.*

To Agree, Initial Here

I certify that the child I am enrolling with this enrollment form is vaccinated for COVID-19. I also understand and agree to the following: PAW enforces COVID safety measures, protocols and policies, some of which are prescribed by the CDC for public safety, some of which are required per each camp location rental and some of which we here at PAW require in order to ensure the safety of each camper, staff member, teacher and family member. This includes, but is not limited to a restriction on camp class/cohort size, allowing only 2 family members to attend any camp performance, temperature checks when children/adults enter the PAW auditorium/space, requiring frequent hand washing/hand sanitizing, requiring everyone on campus to wear a mask, requiring COVID vaccination for all teachers and age qualifying children (age 5 and up).*

To Agree, Initial Here

In the event of an Act of God and/or Force Majeure event, I understand, acknowledge and agree to the following: Based on Performing Arts Workshops’ assessment of public health and safety, PAW reserves the right to switch to or from in-person and online programming platforms or to reschedule the PAW Workshops/Camps/Classes. If an Act of God and/or Force Majeure event occurs once a parent or guardian has paid and registered for any PAW Workshops/Camps/Classes, the full tuition credit (if prior to the start date) or prorated remaining tuition credit (if the session has already begun) can be applied to PAW Workshops/Camps/Classes of the parent’s/guardian’s choosing and is valid for a period of three years from the time of the event. Unused tuition will be deemed to have been forfeited if not redeemed for PAW Workshops/Camps/Classes, in that three year period.*

To Agree, Initial Here

Click Here: Definitions of an act of God and force majeure.

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.*

To Agree, Initial Here