Fields marked with an asterisk (*) are required.

    General Info

    Parent's Name *

    Student's Name *

    Student's Grade - Fall 2019 *

    Contact Info

    Street Address *

    City:*

    State: *     Zip: *

    Parent's Email *

    Home Phone

    Cell Phone

    Emergency and Medical Info

    Emergency Contact's Name *

    Emergency Contact's Phone *

    Does this camper have any allergies? If so, please describe:

    What over-the-counter medications can be administered to camper during camp? Check all that apply:

    Check below if you give Facetime Theatre permission to call for emergency services for your child should a medical emergency arise.

    Camp Info

    My first choice of camps is (check one): *

    If my first choice of camps is full, I (check one): *

    Check below if you would like to participate in both camps.

    Check below if you would like to enroll in extended day.

    Check below if you give Facetime Theatre permission to take photographs and/or video of your child which may be used in future online and print promotional materials.

    Additional Comments or Questions:

    (Upon submission you should be redirected to the Summer Stage Registration Page to make your payment. If you are not, please return to the registration page to send in your payment. Your registration is not complete until we receive your form and your payment. Thank you.)