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

Cost: $300.00
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 ganidjar@comcast.net.
 

Participant’s Name: _______________________________________________Age:______

Address: ________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­__________________________________________________________

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.

 

Print name:_____________________________________________

 

Sign: __________________________________________            Date: ____________