Summer Camp Registration and Emergency Contact Card Participant Name: ______________________________________________ Grade (completed): ________________
Date of Birth: ____/____/____
School: ______________________ Tshirt Size__________
Street Address: ___________________________________________City_______________ Zip_____________ Mother’s Name___________________________
Father’s Name_______________________________
Home Phone _____________________________
Home Phone_________________________________
Work Phone _____________________________
Work Phone_________________________________
Cell Phone ______________________________
Cell Phone __________________________________
Email__________________________________
Email_______________________________________
Pediatrician’s Name_______________________ Phone #_________________ Hospital Pref:_______________ Allergies:____________________________________________________________________________________ In case of Emergency, I give Permission for either of the following people to be contacted and/or to pick up my child from the theater. 1) Name________________________________Phone____________________Relationship_____________ 2) Name________________________________Phone____________________Relationship_____________
Please check all the following that apply: □
Introduction to Acting
July 5 – July 8
8:30am – 11:30am
$140
□
Intro to Theatre Design
July 5 – July 8
12:00pm – 3:00pm
$140
□
Improv for Teens
July 11 – July 15
8:30am – 11:30am
$175
□
Theatrical Dance
July 11 – July 15
12:00pm – 3:00pm
$175
July 18 – July 29
8:30am – 11:30am
$350
□ One Act Workshop (2 weeks) [Performance Included]
Additional Notes: • Programs are designed for students in 7th - 12th grades at all levels of experience • If students are staying a Full Day (8:30am-3pm) they must bring lunch, as it is not provided • Before Care and After Care available if scheduled in advance (additional fees may apply). •
Please make all checks payable to “Pegasus Theater”
• Receive a 5% discount if booking 2 Programs, 10% if booking 2, 15% for 3 or more! • Siblings receive 10% discount on all programs! • To register, return form and 20% non-refundable deposit to: Pegasus Theater Christian Brothers Academy 850 Newman Springs Rd. Lincroft, NJ 07738 • Full payment due before first day of camp. • Please feel free to call 732-907-PEGA (7342) or email
[email protected] with any questions.