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Hand Pile of Happy Group

Summer Camp Registration 
 

Paramount Theatre Centre-Summer Theatre Mini- Camp Registration Form

1124 Meridian Plaza, Anderson IN 46016  (765)642-1234

Cost: $75.00 paid before May 15th ($90.00 after May 15th) Ages: 6-9 years

Camp Dates: June 2- June 6, 2025 – M-F - 9am to 4pm

Student

Birthday

Grade Last Attended in School?


How did you hear about the Paramount Theatre Summer Camp

T-Shirt Size

Dropdown

Emergency Contact Information

Mother

Father

Other Contact

Please list all allergies and/or physical limitations that may affect participation

Physician information

I authorize Paramount Theatre Centre (PTC) to contact the people named above and to authorize the named physician to render such treatment to my child as deemed necessary in an emergency if I am unable to be reached. In the event parents, physician or other people cannot be contacted, PTC staff are authorized to take whatever actions deemed necessary.

Further, this signed statement certifies that my child is medically cleared to participate in the PTC Summer Theatre Camp and to participate in all the activities within the camp while he/she is enrolled in the Camp.

My child’s photograph may be used for future promotional materials with my consent and

in consideration of the acceptance of and participation by my child in the PTC Summer Theatre Camp and the instruction, services, facilities and other assistance to be provided to my child as part of such program, I agree to assume and accept all of the risks and responsibilities in any way associated with the activities engaged in by my child as part of the PTC Summer Theatre Camp, and hereby release PTC (and its board) from any and all liability, claims and actions that may arise from injury or harm to my child or from damage to property in connection with such activities. I also understand that no refund will be issued if my child fails to abide by the PTC discipline code of: 1) Commitment to learning- to do one’s best and not interfere with the learning of others; 2) Consideration of others- always be polite and considerate. Students will not hit, use rude vocabulary or negative remarks; and 3) Respect for property-respect the camp property and others property. Above all, students must be honest.

Date
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