Curio Theatre Summer Camp Registration

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To register, please answer the following questions:

Student's Name *

Student's Age (at time of Camp) *

Camp Session *

Camp Session 1 Camp Session 2 Both Sessions

Student's Grade In Fall 2017 *

What school does your student attend? *

Parent or Guardian *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Main Phone Number *

Secondary Phone Number *

Email *

May we email you regarding future updates/opportunities with the Curio Theatre School? *

Yes No

Emergency Contact Name *

Emergency Contact Number *

Does this student have any medical conditions we should be aware of? *

Will this student need to take medications (including inhalers) during the Camp day? Please list instructions for our staff. *

So our staff can be better prepared, does this student have any physical or learning disabilities? *

Any Allergies, food or medicinal? *

Name of Student's Physician *

Physician's Phone Number *

In case of emergency, do we have permission to take your child to the nearest hospital? *

Yes No

How will your child be getting to and from camp? *

Do we have permission to take photos and or video of your child during class and final showcases for use on our website, newspaper articles and other marketing and grant purposes? *

Yes No

Is your child permitted to go home alone? *

Yes No

If someone other than the parent or guardian will be picking up a student, please list the people who are authorized to pick up your child from school. *

Please let us know how you heard about Curio Theatre School. *

Comment *

SUBMIT