The Curious Place Camp / Program Registration

The Curious Place Theatre is a Program of Spruce Peak Arts

What camp(s) are you registering for?

Student Name

Age

Grade in school 2024/25

Mailing Address

{name}

Primary Parent/ Guardian Name

Primary Email

Primary Parent /Guardian Phone (primary #)

Primary Parent/Guardian relationship to Student

Emergency Contact ( other than Primary Parent/Guardian) Name

Emergency Contact Phone #

Emergency Contact Email

Emergency Relationship to Student

I give Spruce Peak Arts permission for emergency contact to pick up my child.

Please list below any adults who have permission to pick up your child:

{name}

Does your child have any allergies, medications or special health needs?

{name}

Does your child have any behavioral needs or accommodations we need to be aware of?

{name}

Consent for Medical Care: In the event that my child become ill or injured during time at Spruce Peak Arts, I authorize staff to seek emergency care.

I understand fully that even after responsible precautions have been taken, class activities may involve hazards for which Spruce Peak Arts cannot be held responsible.

Medical Insurance- Name of Carrier and Policy Number

{name}

I give Spruce Peak Arts permission to use a participant’s photograph or other media for display on the Spruce Peak Arts website or inclusion in Spruce Peak Arts publications.

T-shirt size

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