Registration Form - SouthWest StageWorks FuturesCamp

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Registration Form - SouthWest StageWorks FuturesCamp

We are taking Registrations for the 23-24 (SW)2 FuturesCamp either onsite or in advance, via this Google Form. Feel free to use either! We're happy to have you back this summer!

Camp fee of $50, to help kickoff this SouthWest StageWorks season, will be payable at the door. Cash or Check only...sorry for any inconvenience!

Please make sure to read through the waivers at the bottom of the form!

- jm

Email *

Student Name *

Age *

Pronouns Used *

If Student uses pronouns other than those above, please let us know what they are below!

School Student's attending this coming year (23-24): *

Grade in school for Student this coming year (23-24): *

School Student attended last school year (22-23) *

Student will be taking the Company Basics sequence (see https://www.southweststageworks.com/sw2-futurescamp.html for details) *

Yes

Student has permission to come/go as they wish/need: *

Student has permission to leave campus for lunch between 1130a and 1230p: *

Primary Parent/Guardian Contact - Name *

Primary Parent/Guardian Contact - Phone Number *

Primary Parent/Guardian Contact - email address *

Additional Parent/Guardian Contact - Name

Additional Parent/Guardian Contact - Phone Number

Additional Parent/Guardian Contact - email address

Alternate Emergency Contact - Name *

Alternate Emergency Contact - Relationship to Student *

Alternate Emergency Contact - Phone Number *

Allergies/Health Conditions for us to be aware of (please enter 'none' if none exist): *

Insurance Provider: *

Policy Number: *

Physician Name & Phone Number: *

There will be interactions with tools, theatrical rigging, and sewing equipment, as well as physically exerting activities....while there will be strong supervision, which must be followed at all times, there is always the small chance of injury. Should that happen, an incident report will be filed with PPS by Mr. Miller and parent/guardian contact will occur.

Without Parent Permission, all students under 16 will be required to stay on campus until picked up by a parent/guardian.

Please acknowledge below that you have read the above cautions and accept these Camp guidelines.

I accept all camp guidelines and look forward to my student taking part in this year's BootCamp

Required

As part of our work to grow our program in the SW Portland/IBWHS Community, we will be taking photos of the activities in progress for publicity and celebration purposes. Please let us know below if your student's image is cleared to be used strictly for archival purposes or sharing (SW)2 work with our community. *

I approve my student's image to be used in archival and social media postings celebrating the FuturesCamp

My student's image should not be used in such postings

Required

Parent/Guardian Name (in lieu of registration signature) *

Send me a copy of my responses.

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