EmailMeForm
Pines Presbyterian Church - Music Theater Camp
"Moses and the Freedom Fanatics" By Hal Hopson
July 22 - 26, 2024 - 9:00am - 2:00pm
Final Performance - Sunday, July 28, 2024 - 10:45am
NOTES
Enrollment is limited and acceptance is based on availability at the time of registration. Parents will be notified if camp has reached capacity.
Your child must be between 5-14 years of age to participate in Music Theater Camp. There will be a snack time each day.
Please fill out a separate form for each child participating.
CHURCH MEDIA PERMSSION
My child’s photo may be used on Pines Presbyterian Church media:
YES
NO
I agree for my child’s photograph to be taken and used in future publicity for Pines Presbyterian Church.
PARTICIPANT INFORMATION
Student Name:
*
T-Shirt Size
*
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Adult XL
Home Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Home Phone:
*
###
-
###
-
####
Alternative Phone:
###
-
###
-
####
Mother’s name:
*
Father’s name:
*
Child’s Date of Birth:
*
MM
/
DD
/
YYYY
(month/day/year)
Parent’s email:
*
Grade your child will be enrolled in, starting the Fall of 2024:
Name of your home church:
EMERGENCY CONTACT
Emergency Contact Name:
*
First
Last
Phone:
*
###
-
###
-
####
Alternative Phone:
###
-
###
-
####
Relationship:
*
Please list and explain any medical conditions and/or food allergies:
PAYMENT INFORMATION
Registration is $10 per child or $25 per family.
(scholarships are available upon request)
3 options with how you may pay:
1. Complete this form and submit the payment form next (to follow).
or 2. Send Check
Please make checks payable to: Pines Presbyterian Church
Write "Music Theater Camp" on the memo line.
Mailing address:
Pines Presbyterian Church
Attention: Music Theater Camp
12751 Kimberley Lane
Houston, TX 77024
or 3. Bring your completed form and payment to the church office front desk and place in Laurie Conner's mailbox.
If choosing options 2 or 3, simply close the online payment window. Your form has been submitted.
AUTHORIZATION
Today’s Date
*
MM
/
DD
/
YYYY
Your child's name:
*
has my permission to attend Music Theater Camp on July 22 - 26, 2024 from 9:00am - 2:00pm. All personal information about my child will not be disclosed at any time. In the event that I cannot be reached in an emergency, I hereby give permission to the physician or EMT personnel selected to secure and administer treatment, including hospitalization, for the participant named above.
Name of parent or guardian:
*
Insurance company name:
*
Policy#
*
Group #
*
Phone number of insurance authorization:
*
Primary care physician name:
*
Primary care physician phone:
*
###
-
###
-
####
> > > NOTE:
If you're paying online, you'll be automatically directed to the secure payment form after clicking on the "SUBMIT" button (below):
On the next form, scroll down to "Music Theater Camp" and specify:
$10/child
or $25/family
