Intro to the Performing Arts Camp 2012 Application

Which site will your camper be attending?: *

Holmesburg

Waterview

Hawthorne

Personal Information

Camper's First Name: *

Camper's Last Name: *

Email: *

Address

Address: *

City: *

State: *

Zip Code: *

Sex: *

Male

Female

Age of Camper (as of July 1, 2012): *

(if your child is older than 10, they will need to sign up for the Young Performer's Theater camp instead. Click here)

DOB: *

Mother/Guardian's Full Name:

Mother/Guardian's Phone

Day:

Evening:

Father/Guardian's Full Name:

Father/Guardian's Phone

Day:

Evening:

School: *

Grade this Past Year:

Emergency Contact

Emergency Contact's Relationship to Camper:

Name and Phone Number of Emergency Contact:

Are you a returning camper to the Intro to Performing Arts Camp?: *

If yes, how many years and which location?:

Experience:

LIST ANY EXPERIENCE, INSTRUCTION, OR FORMAL TRAINING YOU HAVE RECEIVED IN THE PERFORMING ARTS.

After Hours Care:

IF YOU ARE INTERESTED IN EXTENDED AFTER HOURS CARE (2:00-5:00PM), PLEASE CHECK THIS BOX. (THE FEE IS AN ADDITIONAL $30 PER WEEK)

Medical Information

Medical Problems:

PLEASE LIST ANY MEDICAL PROBLEMS OR CONDITIONS OF THIS CAMPER THAT THE STAFF SHOULD BE MADE AWARE.

Medications:

CAMPER'S CURRENT MEDICATIONS (PLEASE EXPLAIN)

Persons Authorized for Pickup:

PLEASE LIST THE NAME, RELATIONSHIP TO CAMPER, & PHONE NUMBER OF THOSE ADULTS AUTHORIZED TO PICK UP YOUR CHILD AT THE END OF EACH DAY

Performing Arts Camp

Vogue Players

All Programs

Events

Organization

© Philadelphia Department of Parks and Recreation Performing Arts Office | 1515 Arch Street, 10th floor | Philadelphia, PA 19102
Site by Context - Philadelphia Web Design
Login