HTAC 2017 Summer Camp Enrollment Form

Camper's Name
Prefix
First
Last
Suffix
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Date of Birth
Grade
School
Parent's Name
Prefix
First
Last
Suffix
Parent's Name
Prefix
First
Last
Suffix
Email
Home Phone Number

###
-
###
-
####
Cell Phone Number

###
-
###
-
####
Work Phone Number

###
-
###
-
####
Emergency Contact Name
Prefix
First
Last
Suffix
Emergency Contact Phone Number

###
-
###
-
####
I give my child permission to walk to lunch each day
 Yes 
 No 
Allergies
Camp Hours are 9am - 3pm. Early Drop Off (8:30am) is available.

I will utilize the 8:30am Early Drop Off
 Yes 
 No 

Camp Package

Camp Package: Please Check
 Four weeks: $1,275 
 Three weeks: $1,125 
 Showstoppers $300 per week 
 Sibling Discount 15% 
A three week minimum is required for registration.
Camp Dates: Please Check
 July 24 - July 28 
 July 31 - August 4 
 August 7 - 11 
 Aug 14 - 18 
Check all that apply. All campers MUST attend at least 3 weeks of camp.

A $150 non refundable deposit is due at the time of registration.

Payment *
 Visa 
 Mastercard 
 Discover 
Credit Card Number *
Expiration Date *
Credit Card ID Number *
By checking this box I authorize HTAC to charge my card *
 Agree 

Haddonfield Theater Arts Center requires a Credit Card to be on file for all students. Payment for camp is due on the campers first day of camp.

By submitting this form I hereby state that:

1) I understand the payment policy of H.T.A.C.

2) I release all members of the Haddonfield Theater Arts Center staff and any other party involved in the organization and administration of Haddonfield Theater Arts Center from any liability as a result of any injury sustained in or around Haddonfield Theater Arts Center venue.
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