2018 Summer Camp Form

Damsels, Daggers, and Death

Dates: June 11 – 15
Ages: 11-16


Times: 9am-3pm (Extended Care is also offered 8am-9am & 3pm-4pm, $10/hr)

Fee: $225/week. $200 per child if siblings are participating, and also $200 for Bardling members.

Location: Goodwood Museum and Gardens





Child's Name*

Choose Camp(s)* Damsels, Daggers, and Death Part IDamsels, Daggers, and Death Part II

Grade Entering Fall 2018*

School*

Date of Birth*

Gender*

Additional Child's Name

Choose Camp(s)* Damsels, Daggers, and Death Part IDamsels, Daggers, and Death Part II

Grade Entering Fall 2018

School

Date of Birth

Gender

Mailing Address

Parent/Guardian Name*

Parent/Guardian's Phone*

CellHomeWork

Parent/Guardian's Email Address*

Additional Parent/Guardian's Name

Additional Parent/Guardian's Phone

CellHomeWork

Additional Parent/Guardian's Email Address

Emergency Contact's Name

Emergency Contact's Phone

CellHomeWork

Emergency Contact's Email Address

Emergency Contact's Relationship to Camper

Alternate Persons Authorized to Pick Up Camper

Name

Phone

CellHomeWork

Name

Phone

CellHomeWork

Health Information

Medications Taken Regularly

Allergies

Health Insurance Company Name

Health Insurance Company Policy #

Physician's Name

Physician's Phone

Parental Authorization For Emergency Treatment

Should my child become ill or suffer an accident during the time that he/she is in the care of Southern Shakespeare Company, the camp will contact me immediately. In the event that the camp is unable to reach me immediately, I authorize Southern Shakespeare Company to secure medical attention for my child as may be necessary.
YesNo

Parental Authorization For Pictures

Do you give your permission to have your child's picture taken and displayed at Southern Shakespeare Company Summer Camp or on the Southern Shakespeare Company website?
YesNo

What is your child's t-shirt size? Each camper and parent will receive a free Southern Shakespeare Camp t-shirt.
Child 1:
Child 2:

Is there anything special we should know about your child? Can he/she participate in all camp activities?

I am interested in the before-care option (8am - 9am) and/or after-care (3pm – 4pm) for my child for an additional $10/hr.
YesNo