PREPAID SGT Academy Summer Camp '23 Registration Form
Mt. St. Mary Academy, 3756 Delaware Avenue, Kenmore, NY 14217

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Email *
Please complete a SEPARATE form for each camper. Registration won’t be considered complete until payment and form is complete and submitted. Please initial to accept this.

SD
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Student's Full Name:   Briella Dennee *
Preferred pronouns:
she/her
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Age: 11 *
Date of Birth: 9/25/11 *
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Parent/Guardian Full Name:  Steve Dennee *
Address:  47 Seton Rd  *
City, State   Cheektowaga  *
Zip Code. 14225 *
Primary Phone Number
716-713-5882
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Secondary Phone Number.  716-440-7959 (Bri’s mom)
716-713-5872 
716-440-7959

Emergency Contact and Phone Number
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Doctor Name and Phone Number
Williamsville Pediatrics 
(716) 631-3510
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Please list all known allergies, physical limitations, and concerns

No known allergies at this point 
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Theatre Camp Dates for Ages 6-14

*NEW* PLEASE NOTE*
Late pickup is available every day but Friday until 5:30pm for $7/half hour. To make use of this service, please notify SGT staff no later than the morning of said pickup. Your credit card will be billed at the end of the week. 


BOTH WEEKS
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PLEASE READ SGT CAMP POLICIES & SIGN WAIVER

-ENROLLMENT & REFUNDS: 100% Refunds will ONLY be issued prior to the start date of the camp.

-Campers are expected to be respectful of MSM’s space- no gum, food, or drinks other than water are permitted in the classroom

-Please notify SGT at (716) 508-SGT0 or education@2ndgentheatre.com if you know a student is going to miss the day or be late!

(Initial to accept these policies)
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WAIVER

Second Generation Theatre Company, its instructors, and the various facilities are not legally held responsible for any illness, accidents, or injury that may occur to you, an adult caregiver accompanying your child, and your child. By signing or printing your name on this document, you agree to accept full responsibility for yourself and child while attending SGT summer camp. 


I have read the SGT Camp policies and waiver and agree to accept them. All the information on this registration form is accurate to the best of my knowledge


SD.


(Please initial to accept this waiver)

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SGT Summer Theatre Camp Photo Release Form

I hereby authorize Second Generation Theatre Company, Inc. (SGT) to publish the photographs taken of me and/or the undersigned minor children, and our names, for use in SGT’s printed publications and website.

I release SGT from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize SGT to use their photographs.

I acknowledge that since participation in publications and websites produced by SGT is voluntary, neither the minor children nor I will receive financial compensation.

I further agree that participation in any publication and website produced by SGT confers no rights of ownership whatsoever. I release SGT, its officers, trustees, and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor child.

(Initial below to confirm that you have read and accept this photo waiver.)


SD

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A copy of your responses will be emailed to the address you provided.
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