Adam Swartz Puppets Summer Camp Registration 2024
Please complete the following registration form and mail your payment to Adam Swartz Puppets: 
215 Delaware Rd. Pa Furnace, Pa 16865.  Or, make your payment via Venmo @adamswartzpuppets or 
Paypal: paypal.me/adamswartzpuppets2. Thank you! 
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Email *
Which week(s) of camp/workshops are you registering for? *
Required
Camper/participant First and Last Name *
Camper Age
Camper Grade in 2024-2025 school year
Additional Camper/participant First and Last Name
Additional Camper Age
Additional Camper Grade in 2024-2025 school year
Parent/Guardian Name(s) *
Preferred Phone *
Alternate Phone
Camper/participant Mailing Address *
Camper T-Shirt Size
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Additional Camper T-Shirt Size
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During camp, we may take photographs to share with camp families. We also may create video projects during camp. These photos and videos may also be used by Adam Swartz Puppets for printed or online promotional material. Campers will never be identified by full name in photos or videos. Additionally, we may take pictures or make videos during workshops. Please check the boxes below to indicate your permission.
List anyone else with permission to pick up your child(ren):
List any medical or physical conditions, including allergies, teachers should be aware of:
Medication(s)/Dosage(s):
Prescribing/treating physician name/Phone number:
Other special needs or comments:
By checking this box and entering my name below, I indicate that I permit my child(ren) to participate in summer camp on the above dates. I also authorize any medical treatment in case of an emergency, and agree that I am responsible for the cost of such treatment. I agree to release, hold harmless and indemnify Adam Swartz Puppets and its agents, representatives and employees, from all claims, damages, or other liabilities for injuries to my son/daughter which are not the result of gross negligence, intentional neglect, or willful or wanton conduct by said agents, representatives, or employees. *
Required
Enter your name to indicate your permission. *
A copy of your responses will be emailed to the address you provided.
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