Elefante Music & School for the Performing Arts

Musical Theater Camp 2022 Registration

Instructions: Fill out this form and click SUBMIT. You will receive an email confirmation shortly after your submission is received and payment has been successfully completed.

"*" indicates required fields

Student Name*

First Last

Parent/Guardian Name*

First Last

Grade in 2022–2023 School Year*

Select the grade the student will be ENTERING in fall 2022. Please note that the minimum grade requirement is entering kindergarten.

NOTE: For students entering grades K or 1, slots in Session 2 (July 18 –July 29) and Session 3 (August 1 – August 12) are full. However, there are still slots available for students entering Kindergarten and 1st grade in Session 1 (July 5 – July 15)

If you are registering your Kindergartener or 1st grader for Session 1, you may continue with registration below. If you are only interested in Session 2 or Session 3, email karen@elefantemusic.com with any questions, or to be placed on a waiting list.

Student Age on July 1, 2022*

Student Date of Birth*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Will be used as primary phone number.

Email*

Emergency Contact Phone Number*

Emergency Contact Name*

First Last

Previous instrumental music, voice, acting, or dance experience. If any, please indicate and for how long:

Does your child have an allergy that requires the use of an Epi Pen?*

Yes

My child is allergic to:*

Check all that apply from the 3 choices below*

An Epinephrine injector has been prescribed for my child.

A device designed for self-administered asthma treatment (not necessarily Epinephrine) has been prescribed for my child.

My child has received adequate training on how and when to use an Epinephrine injector and can use it properly in case of an emergency. He or she will carry Epinephrine injectors at all times.

Authorization to allow self-administration. Select one of the options (required).*

I hereby authorize...

I hereby DO NOT authorize...

...my son/daughter to self-administer the epinephrine auto-injector (Epi-Pen® or similar devices designed for self-administered asthma treatment). I agree to indemnify and hold harmless Elefante Music and School of Performing Arts and any of its staff, volunteers, or agents from lawsuit, claim, loss or expense, demand, or action against them, including reasonable attorneys’ fees, suffered by any of the foregoing indemnities and arising out of a claim related directly or indirectly to my son/daughter’s self-administration of or failure to self-administer the above referenced epinephrine auto-injector.

Authorization to allow staff to administer auto-injector. Select one of the options (required).*

I hereby authorize...

I hereby DO NOT authorize...

...Elefante Music and School of Performing Arts staff and volunteers to administer an Epinephrine injector (Epi-Pen® or similar devices designed for self-administered asthma treatment) to my child if he or she appears to have had significant exposure and/or a severe allergic reaction to a specified allergen. I agree to release, indemnify, and hold harmless Elefante Music and School of Performing Arts and any of its staff, volunteers, or agents from lawsuit, claim, expense, demand, or action against them, including reasonable attorneys’ fees, suffered by any of the foregoing indemnities and arising out of a claim related directly or indirectly to administering or failing to administer the Epinephrine injector. I am aware that the injection will likely be administered by a staff member or volunteer who is not a healthcare professional.

Any medical or emotional issues you would like us to be aware of:

Consent to Treat in the Event of a Medical Emergency*

If you cannot be reached in an emergency, do you give permission to the proper medical staff to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child, understand the information on this form will be shared on a "need to know" basis with Elefante Music staff?

I agree.

COVID Procedures Agreement (Required)*

I understand and agree that if my student is not feeling well, or if they or my family is under quarantine, they will not attend camp at that time. I further understand that while the current camp policy is mask-optional, said policy may be subject to change in response to fluctuating viral conditions, or in potential situations in which children attending a given camp session or class are known to be immune-compromised. In addition, I understand that Elefante Musical Theater Camp is a Pingry Partner Camp and, as such, will adhere to all campus safety policies set forth by The Pingry School, and that said policies are subject to change.

I agree.

T-Shirt Size*

Musical Theater campers receive a free t-shirt! Please select the student's size below. Sizes tend to run large.

May we use photographic images and sound bytes of your child for promotional material?*

Yes

How did you hear about us?

Musical Theater Camp (Base)

Camp Session Selection*

Select the session(s) for which you wish to register. Receive a $100 discount when you register for all 3 sessions. To receive the $100 discount, make sure you check all 3 sessions below. The discount will automatically apply.

SESSION 1: July 5 – July 15 (9-day session due to holiday)

SESSION 2: July 18 – July 29 (10-day session)

SESSION 3: Aug 1 – Aug 12 (10-day session)

Select Camp Session*

Select the session(s) for which you wish to register.

SESSION 1: July 5 – July 15 (9-day session due to holiday)

Discount

$0.00

Payment Method

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Total

By clicking submit, you authorize your card to be charged for this amount:

Ready to register? Read this first:

Click SUBMIT ONLY ONCE and DO NOT refresh your page or click the Back button.

If you click SUBMIT but receive an error message, email karen@elefantemusic.com (rather than registering again, as in many cases we will still receive your registration).

THANK YOU!

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