Summer Theatre Workshop

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Registration Form

Email *

Student Name: *

Student Birthday: *

YYYY

Their Pronoun

Track *

Acting performance Both weeks

Set Building/Design Both weeks

Set Building/Design July 15-19th Only

Set Building/Design July 22-26th Only

Required

Parent/Guardian 1

Name *

Address

Phone Number *

Parent/Guardian 2

Name

Address

Phone

E-mail

Payment information and checklist

Enclosed

$25 nonrefundable registration (due with application)

$400 ($200/week) Full payment due by the first day of camp

$20 Production fee

Early drop-off @8am ($5/day*)

Late pick-up by 5pm ($5/day*)

*If you are unsure if or which days you will take advantage of these services, you may pay daily as you use them during the two week camp. If you know that you will need the service and when you will need them, please include payment today and list days for each service below.

Early Drop-Off Days (if needed)

Late Drop-Off Days (if needed)

Total Payment today

This is a two-week long workshop culminating in a performance. Acting students are require to participate in both weeks. Set building/design students may choose 1 or both weeks this year only.

Payments can be sent:

By Mail: Karen Jamiel, First Light Theatre Project, 24 McIntosh Ave, South Burlington, VT 05403
By Venmo: @firstlighttheatreproject
By PayPal: paypal.me/firstlighttheatrevt

Cancellation Policy

There is a non-refundable $25 registration fee. All other fees paid two weeks prior to the start of camp with be refunded. If there are fewer than two weeks before camp starts, 50% will be refunded. No refunds will be made after camp starts.

Parent/Guardian Signature *

Emergency Contact

Name *

Phone Number *

Relationship *

Medical Realse

As the undersigned parent and/or legal guardian of the student listed above, I hereby give permission for my student to be given emergency treatment as needed by members of the First Light Theatre Project. I give my permission for the student for the student to be transported by ambulance to an emergency center for treatment. In the event that I, my student’s emergency contact or my preferred physician cannot be contacted, I consent to medical, surgical, and hospital care treatment and procedures to be performed for my child by a licensed physician or hospital when deemed immediately necessary or advisable by a physician to safeguard my child’s health. I agree the I will not hold First Light Theatre Project or any member of its staff liable for damages, injuries or losses during the student’s participation in this educational program.

Parent Signature *

Physician and Insurance Information

Physician's Name

Phone #

Insurance Carrier

Policy #

Any additional insurance information

Please list any important health-related information about your child (allergies, medications, special learning needs). If your child is required to take medication regularly, please include that information along with any instructions.

Photo/video release

As the undersigned parent and/or legal guardian of the student listed above, I hereby give permission to First Light Theatre Project to use photographs, audio and/or video recordings of my student for fundraising and/or marketing purposes. On occasion, student photographs may be included in promotional videos, on the First Light Theatre Project website, and on social media sites.

Parent/Guardian Signature *

Participant Consent

As a First Light Theatre Project Summer Workshop participant, I consent to participating in any and all workshop activities, unless prohibited by a physician. I understand that First Light Theatre Project and its staff will provide a safe place for me to grow and learn more about my interest in the performing arts.

Student Signature *

Parent/Guardian Consent

As the parent/legal guardian of the above First Light Theatre Project Summer Workshop participant, I give my permission for my student to participate in any and all workshop activities, unless prohibited by a physician. I understand that First Light Theatre Project and its staff will provide a safe place for my student to grow and learn more about the performing arts.

Parent/Guardian Signature *

If you have any questions, please contact:

Karen Jamiel
Administrative Director
firstlighttheatrevt@gmail.com

Send me a copy of my responses.

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