Nerds' Club: Dungeon & Dragons Edition

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Nerds' Club: Dungeon & Dragons Edition - July 2-5, 2019

Nerds Club Camp. July 2-5, 2019. 9:00 a.m. - 4 :00 p.m. (Please note this is a 4 day camp due to Monday, July 1st being a statutory holiday.) Extended Hours available at additional cost. Roseneath Theatre is located at 651 Dufferin Street. For any questions or concerns please contact 416-686-5199 ext 227. *** Please note if registering additional siblings please complete this registration form for each child***

Email *

Child's Last Name *

Child's First Name *

Child's Pronoun *

Child's Age *

Parent/Guardian's Full Name *

Full Mailing Address (For Invoices) *

Phone Number *

Emergency Contact *

Emergency Contact Phone Number/ Contact Information *

Does your child have any dietary restrictions or allergies? *

Are there any access needs, challenges, anxieties/fears that staff should be aware of? *

Does your Child have any nerdy interests? *

Does your child have experience playing Dungeons and Dragons? How often do they play?

Please note invoices will be issued. Please refrain from sending payments until invoice is received.

Invoices can be paid via Email Money Transfer, and Gift Certificate

Please Confirm Fees applicable with this application form *

Single Camper Fee ($220 per camper for 9am-4pm)

Sibling Registration ($200 per camper for 9am-4pm)

Early drop off 8:30am - 4:00pm - (Additional charge of $25 for the week)

Late Pick Up (5:00pm - additional charge $45 for the week)

I have a full or partial scholarship or gift certificate

Required

Release Statement

I am the parent or legal guardian of the child mentioned above (the “Student”), who is under 18 years of age. I agree that the Student participate in the full school programs and activities (the “Activities”) of the Drama school of Roseneath Theatre (the “Theatre”). I acknowledge that I must advise the Theatre in writing if the Student is not physically fit to participate fully in the Activities. I also acknowledge that there are risks in participating in the Activities. I agree that, having taken such precautions as in its discretion are deemed advisable, the Theatre will not be held responsible for any injury, sickness or accident to the Student or for any loss or damage to personal property resulting from the Student participating in the Activities. I authorize the Theatre to secure medical care for the Student. If for any reason the Student requires medical attention beyond any first aid furnished by or on behalf of the Theatre, I agree to be responsible for any expenses incurred. I agree to indemnify the Theatre, its officers, directors, agents and employees and save them harmless from and with respect to all suits, actions and prosecutions by reason of any Activity carried out by the Student, whether on or off the Theatre’s property.

Do you agree with this release statement? *

Yes

Media Release

I consent to the use of the likeness (including still photographs and video) of the Student in connection with the drama programs of the Theatre and related institutional promotional purposes throughout the world and without any compensation. I expressly release the Theatre, its officers, directors, agents, employees, licenses and assigns from and against any and all claims for invasion of privacy, defamation, infringement of copyright or any other cause of action that may arise out of such use. I hereby irrevocably release the Theatre from any and all claims for libel and invasion of privacy in connection with the foregoing.

Do you consent to the use of photography and video? *

Yes

Thank you for Registering!

Invoices and confirmation email will be sent out 1-3 business days of registration.

Send me a copy of my responses.

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