2024 Trolls Summer Camp Registration/Contact/Release Form

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Untitled Question

Option 1

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Student's Name *

Student's date of birth *

YYYY

Student's Hearing Status *

Deaf

Hard of Hearing

Hearing

CODA

If your child is Deaf or HOH do they have any assistive devices that they use? *

Hearing Aids

Cochlear Implant

My child is not Deaf or HOH

Other:

If your child is Deaf or HOH what is their primary mode of communication? *

ASL only

Bilingual ASL/Spoken English

Spoken English Only

My child is not Deaf or HOH

Parent(s) / Guardian(s) Email
*

Parent(s) / Guardian(s) Name
*

Address
*

Primary Phone Number
*

Secondary Phone Number
*

Emergency Contact
*

Emergency Contact Phone Number
*

Medical Concerns / Allergies
*

Names of those who can pick up my child(ren):
*

I give permission for Hands Up Silent Theatre to photograph / video my child during class and at performances which maybe used for advertisements and practice videos.
*

I agree

I do not give permission

I understand I must provide my child with a cold lunch and a snack everyday. *

I understand

Payment

A $100 deposit must be received by 4/1/24

The $450 balance is due on or before the first day of camp.

Your child(ren) can not start camp until the full tuition is paid.

VENMO @handsup
PAYPAL handsupsilenttheatre@gmail.com

I understand my commitment to pay on time and as outlined above.

I hereby permit my child to attend Trolls Summer Camp at Hands Up Silent Theatre. I hereby release and hold harmless Hands Up Silent Theatre, including staff, volunteers from all liability and from all actions or claims that my child now or hereafter have for damage or injury to my child, or to any person or property resulting from the negligence or other acts of any staff or volunteers in connection with my child’s participation.
*

I agree

I disagree

Parent/Guardian Signature (type for signature)
*

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