2022 Curio School Registration Form

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Please fill out this form completely. If there are any questions please feel free to contact Education Director, Tessa Kuhn, at tessa@curiotheatre.org or call 215-921-8243.

Thank You!

Name of Guardian

First Name of Student *

Last Name of Student *

Age of Student *

Grade of Student

School Student Attends

First Name of Guardian *

Last Name of Guardian *

Relationship to Student *

Desired Class *

2022 Summer Camp Session 1 / July 5 - 15

2022 Summer Camp Session 2 / July 18 - 29

2022 Summer Camp (Both Sessions)

Required

Phone Number

Address *

Email *

Emergency Contact Number *

Name of Emergency Contact *

Primary Care Information

In our interest to best serve your child, please provide the information below.

Name and Number of Primary Care Physician *

Does your child have any illnesses, injuries, or limitations to physical activities we should be made aware of? *

Does your child have any learning disabilities that we should be made aware of? *

Is your child taking any medications that we should be made aware of? *

Does your child have any allergies to food or medications? *

Name of child's physician and contact phone number: *

In case of emergency do we have your permission to take your child to the nearest hospital? *

Yes

Required

Almost There! Please provide info on your child's transportation to class and permissions.

How will your child be getting to and from class? *

Is your child permitted to walk home alone? *

Yes

Required

If No, who has permission to pick up your child?

Do we have permission to take photos and video of your child during class and final showcases for use on our website, newspaper articles, and other marketing and grant purposes? *

Yes

Required

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