Musical Theater Camp 2024 Registration Instructions: Fill out this form and click REGISTER. You will receive an email confirmation shortly after your submission is received and payment has been successfully completed. "*" indicates required fields Camper Name* First Last Parent/Guardian Name* First Last Camper's Grade in 2024–2025 School Year*Select the grade the student will be ENTERING in fall 2024. Please note that the minimum grade requirement is entering kindergarten. PLEASE SELECT FROM BELOWEntering Kindergarten in Sept. 2024Entering 1st grade in Sept. 2024Entering 2nd grade in Sept. 2024Entering 3rd grade in Sept. 2024Entering 4th grade in Sept. 2024Entering 5th grade in Sept. 2024Entering 6th grade in Sept. 2024Entering 7th grade in Sept. 2024Entering 8th grade in Sept. 2024T-Shirt Size*Musical Theater campers receive a free t-shirt! Please select the student’s size below. Sizes tend to run large.Youth XSYouth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult XXLCamper's Age on July 1, 2024* Camper's Date of Birth* Month Day Year Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Cell Phone Number*Email* Emergency ContactsEmergency Contact #1 Name* First Last Relation to camper* Emergency Contact #1 Phone Number*Emergency Contact #2 Name* First Last Relation to camper* Emergency Contact #2 Phone Number* Allergy/Medical DisclosureDoes your child have an allergy that requires the use of an Epi Pen or a device designed for self-administered asthma treatment (not necessarily Epinephrine)?* Yes No 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 their device, and can use it properly in case of an emergency. Auto-Injector Staff Administration Consent*I 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 they appear 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. Note: all children for whom an Epinephrine injector has been prescribed MUST bring the injector to camp with them every day. The injector must be in a plastic bag clearly-labeled with the child’s name. I authorize staff to adminster auto injector.Any medical, emotional, or special needs you would like us to be aware of: Camper Pick-Up*In the space below, please list the names of all persons who have permission to pick up your camper(s). Please include first and last name, and relationship to the camper. "Keep-Togethers"In the space below, please note if there are any other campers you would like your child to be grouped with. We cannot guarantee they will be together, however we will do our best to accommodate you. We request that you please provide this information now, as we may not be able to change assignments when the camp start-time approaches. Camp SelectionMusical Theater Camp 2024Select Your Session(s)*Select your session(s) from the list below. Note: there is no camp on July 4th, which accounts for the price difference. Session 1 July 1 to July 12 Session 2 July 15 to July 26 Session 3 July 29 to August 9 Discount $0.00 AgreementsConsent 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 to the medical emergency policy.Pingry's lunch policy agreement*In order to keep all campers with allergies safe, Pingry requires all campers to participate in their lunch program. Absolutely no outside food, including snacks, are allowed. The lunch fee is included in the cost of registration. I agree to Pingry’s lunch policy.Cancellation policy and fees*By registering for camp, you agree to the following cancelation policies. Cancel before 6/1: full refund Cancel between 6/1 and 6/8: $50 fee Cancel between 6/9 and 6/15: $75 fee Cancel between 6/16 and 6/22: $100 fee Cancel between 6/23 and 6/30: $150 fee Cancel on or after 7/1: $200 fee I agree to the cancellation policy and applicable fees.Code of Conduct and Core Values*Elefante Music and School for the Performing Arts maintains a high standard of educational excellence. As such, we require that all students attending lessons, classes, camps, or similar activities read and adhere to our Code of Conduct and Core Values, which can be viewed VIA THIS LINK. After reading, hit the back arrow(s) to return to this form. I have read and agree that my child will comply with Elefante Music’s Code of Conduct and Core Values.May we use photographic images and sound bytes of your child for promotional material?* Yes No How did you hear about us? Previous attendee Friend or family member Internet search Social media elefantemusic.com Other PaymentCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name TotalYou authorize your card to be charged for this amount: Click REGISTER ONLY ONCE and DO NOT refresh your page or click the Back button. If you click REGISTER and receive an error message, email email@example.com (rather than registering again, as in many cases we will still receive your registration).