Youth Camp Registration Form

(Please print and complete)

Pirates of Penzance summer youth camp

Summer 2018 Registration Form

 

Monday-Friday, 9AM-4PM, July 9-20 plus performances July 20-22 (Fri at 7, Sat at 7 and Sun at 2.).  Rehearsals & Performances at Seattle Gilbert & Sullivan Society, Crown Hill Center, 9520 14th Ave. NW, Seattle, WA 98117.  Tuition $675 (grades 5-9*) / $350 (grades 10-12).  10% sibling discount.  *Partial scholarships available to any families in need.  Please select:

 

______Performer (entering grades 5-9).       

______Performing intern (entering grades 10-12)

______Tech intern (entering grades 10-12). 

Everyone (actors & tech) please circle interests: costumes, props, set, lights, sound, stage management

 

Performing interns participate alongside younger students in the show and are eligible for any role.  They are expected to model strong rehearsal skills and assist younger performers as need.  Tech interns will work under supervision of tech and directorial staff and should be present at all rehearsals and performances. 

 

Student’s name: _______________________________________ Date of Birth: ____________

School: __________________________________________________ Entering Grade: _______

Parent/Guardian 1: Name: ____________________________ Relationship to student: ______

Address: __________________________________City___________________ Zip __________

Home phone: __________________Work:_________________ Cell: _____________________

E-Mail: _______________________________________________________________________

Parent/Guardian 2: Name: ____________________________ Relationship to student: ______

Address: __________________________________City___________________ Zip __________

Home phone: __________________Work:_________________ Cell: _____________________

E-Mail: ______________________________________________________________________

If applicable, student cell phone: _________________ Student email: ____________________

What is the best way to contact your family? ________________________________________

May we share your names and parent contact info on a camp roster (for participants only)?____

Emergency contacts (name, relationship & phone number):

1) __________________________________________________________________________

2) ___________________________________________________________________________

Release permission:  

My student can go home by his/herself (circle one).   Yes / No

My student can be picked up by the following people___________________________________

How did you hear about us? _______________________________________________________

What is your child’s experience with acting, singing and/or dance? ________________________

______________________________________________________________________________

Any special talents (e.g. musical instrument, acrobatics, juggling, etc?) ____________________

______________________________________________________________________________

What are your child’s interests, hobbies, and strengths? _________________________________
______________________________________________________________________________

Please describe any special medical concerns, allergies, dietary restrictions, physical, social/emotional or behavioral conditions or learning challenges that may affect your child’s participation and let us know how we can best support your child: _______________________

_____________________________________________________________________________

_____________________________________________________________________________

______________________________________________________________________________

Is there anything else that would be helpful for us to know about your child? ________________

______________________________________________________________________________

Emergency Treatment/ Liability Release:

In the case of an emergency, I hereby authorize representatives of Seattle Gilbert & Sullivan Society (SGSS) or Theater of Possibility (TOP) to seek medical assistance at the nearest medical facility and I the undersigned will be responsible for all medical costs and transportation necessary.  I hereby release SGSS and TOP from liability for damages, injuries or loss to my child during or resulting from his or her participation in this camp and waive any claim against SGSS and TOP, and their agents, employees, or servants, whether paid or volunteer.

 

Parent’s signature:  _____________________________________  Date: _________________

                        (or signature of participant 18 years or older)

Signer’s Name (Print): ___________________________________________________________

Hospital preferred: _________________________ Child’s physician: _____________________  Physician’s phone: ______________________  Medications: ____________________________

Media Release:

By signing the release above, I hereby allow SGSS and TOP to use my child’s likeness in still or moving picture format in any of its publications, for publicity or any other lawful purpose. If you would like to withhold that permission, please check here:

 

Please return this signed form and $100 deposit to: Youth Programs, Seattle Gilbert & Sullivan Society, 9520 14th Ave NW, Seattle, WA 98117.  The tuition balance is due by June 1, 2018, unless other arrangements have been made.  Please contact youthprograms@pattersong.org  or Lauren Marshall at 206 321-4923 if you have any questions. Thank-you!

 

Sponsored by Seattle Gilbert & Sullivan Society & Theater of Possibility

 
 

It all started when…

The following is placeholder text known as “lorem ipsum,” which is scrambled Latin used by designers to mimic real copy. In sit amet felis malesuada, feugiat purus eget, varius mi. Vivamus sit amet semper lacus, in mollis libero. Sed a ligula quis sapien lacinia egestas. In sit amet felis malesuada, feugiat purus eget, varius mi.

Fusce at massa nec sapien auctor gravida in in tellus. Donec eu est non lacus lacinia semper. Nulla lectus ante, consequat et ex eget, feugiat tincidunt metus. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Nullam sit amet nisi condimentum erat iaculis auctor.