2024 MOMO Theatre Kids Camp Registration

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Email *

Camper's Name (First and Last) *

Camper's Age *

Camper's Date of Birth *

YYYY

Camper's Address *

Home Phone *

Cell Phone *

Parent/Guardian Names and Daytime Phone *

School Grade Completed *

Parent /Guardian Email (please use one you will check constantly. All communication will be through email) *

Camper's Shirt Size *

Camper's Pant Size *

Camper's Shoe Size *

Camp Preferred *

Finding Nemo, Jr (June 10-22) (Currently full. By choosing this option, you will go on the waitlist and will be emailed if a spot opens up)

The Lion King, Jr (July 22-August 3) (Currently full. By choosing this option, you will go on the waitlist and will be emailed if a spot opens up)

Required

Week 1 Monday-Friday of each camp will be 10am-4pm (campers bring their lunch). Week 2 is tech rehearsals (times will be in the evenings but are currently TBA Monday-Thursday, and performances will be Friday and Saturday.

PERFORMING ARTS EXPERIENCE

List any theatre workshops you have attended *

List any theatre performances you have been in (when and where) *

List any special skills or talents (musical instruments, gymnastics, vocal performance, etc.) *

Are you currently studying: *

Voice

Dance

Music

None

If so, where, with whom, and how long? *

Instruments played and how long? *

EMERGENCY INFORMATION

Emergency Contact Name *

Emergency Contact Phone Numbers *

Do you have any allergies? If so, please list *

Do you have any allergic reactions or medical conditions that might require immediate attention? *

Yes

If so, what treatments are necessary? *

If you carry medication that should be administered, what is it and where is it kept? *

If you are currently taking any medication that could affect an emergency, please list medicines and how to handle the emergency *

Physician's name and phone *

Health Insurance Carrier & Policy Number *

Please list the names and number of individuals allowed to pick your child up from the theatre *

RELEASE: I understand that in the performing arts/workshops there is a potential for injury, and I hereby grant Mountain Movers Theatre Company personnel permission to obtain emergency medical care for my child and accept responsibility for any medical and other costs resulting in said injury. I hereby release Mountain Movers Theatre Company and any third-party facilities used by Mountain Movers Theatre Company from any liability resulting from the same. FACILITIES ARE HANDICAPPED ACCESSIBLE. *

Yes

Parent/Guardian Signature and Date *

Submit

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