Oldwick Community Players Summer Camp Registration Form
July 9-20, 2018
Church of the Holy Spirit
3 Haytown Road
Lebanon, NJ 08833
Mondays, Tuesdays, Wednesdays and Friday from 2-5PM; Thursdays from 3-6PM
In addition on July 20, campers can stay for Dinner and Show Prep from 5-7PM, followed by a Performance/Reception for Family and Friends from 7-9PM
Mail a $300 check made out to Oldwick Community Players and the completed form to 142 1/2 West End Ave., Somerville NJ 08876
Alternatively, PayPal can be used for the registration fee and the completed form can be emailed to email@example.com.
Participant’s Name: _______________________________________________Age:______
Parent 1 Name: _____________________________________________________________
Parent 1 Address (if different from above): ________________________________________
Parent 1 Home Phone: ___________________ Parent 1 Cell Phone: ____________________
Parent 1 Business Phone: _________________Parent 1 Email Address: __________________
Parent 2 Name: ______________________________________________________________
Parent 2 Address (if different from above):_________________________________________
Parent 2 Home Phone: ______________ Parent 2 Cell Phone: ____________________
Parent 2 Business Phone: ____________Parent 2 email address: ___________________
If anyone else is authorized to pick camper up, please specify name and contact info:_____________________________________________________________
If your child is allowed to leave the building unaccompanied by an adult, please sign here.
Print name:__________________________________ Sign here:____________________
Physician Name: _____________________________________________________
Physician Phone Number: ______________________________________________
In the event of a medical emergency, if parents cannot be reached, I hereby authorize representatives of Oldwick Community Players (OCP) to contact the physician named above directly. I authorize the named physicians in this form to render treatment as may be deemed necessary in an emergency, for the health of my child. I will not hold Oldwick Community Players or its representatives financially responsible for the emergency care and/or transportation for said child. By signing, I release OCP from any responsibility connected to my child being injured during the course of the workshop.
Signature: ____________________________________________ Date: ____________
Allergies, please list all: _______________________________________________
Is there anything else you would like the teachers involved in the camp to know about your child’s individual needs?
During the course of the program, pictures and video may be taken and used on social media including newspapers, ads, website and Facebook. By signing you agree to give us permission to include your child.
Sign: __________________________________________ Date: ____________