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COME AND MEET US AT OUR OPEN HOUSE! SATURDAY APRIL 20, 2024 AT NOON! to HEAR MORE ABOUT OUR FUN THEATRE SUMMER THEATRE CAMP 2024! LOCATION: @ Boca Universal Stage, UUFBR 2601 St. Andrews Blvd. Boca Raton, FL 33434 Email: Contact@Rmctonline.com
__________________________________________________________________ REGISTRATION FORM FOR THEATER SUMMER CAMP PLEASE COMPLETE THIS FORM AND RETURN IT TO Contact@rmctonline.com 1. STUDENT’S NAME #1: _________________________________________________________
2. STUDENT’S NAME #2: _________________________________________________________
3. AGE: _______ BIRTHDAY: _______/_______/____________ GRADE FALL: __
4. PARENT/GUARDIAN NAMES: __________________________________________________ ________________________________________________________________
5. ADDRESS: _______________________________________________________________ ________________________________________________________________
6. PHONE: ____________________________________
7. EMAIL: ______________________________________
8. EMERGENCY CONTACT NAME: ________________________________________________
9. PHYSICIAN: ________________________________________________________________
10. ACTIVITY RESTRICTIONS: _______________________________________________________________
11. MEDICAL ISSUES/CONDITIONS: _______________________________________________________
12. ALLERGIES/DIETARY RESTRICTIONS: ______________________________________________________ ________________________________________________________________
13. List all medications your child is taking now: __________________________________
14. Child’s Health Insurance and Policy number: ______________________________________________________
MEDICAL RELEASE FORM In case of a medical emergency, we must have your written permission to seek immediate medical attention for your child.
I assume all risks and hazards incidental to participating, and do hereby waive, release, absolve, indemnify, and agree to hold harmless Rocky Mountain Conservatory Theatre, their staff, volunteers, program location venue, and any sponsoring agency for any claim arising out of loss or injury that the participant might sustain while engaged in this program. I understand that insurance is not provided and that none of the sponsoring agencies are responsible for the medical condition of the participant in the space provided above. I give permission to the authorized RMCT personnel to administer medication to my child if it is deemed necessary in any circumstances. In the event that I cannot be reached in an emergency, I give permission to the physician selected by the RMCT Directors to hospitalize and secure proper measures of treatment for the child named above. Medical bills will be the responsibility of the parent or guardian named above. The information above in this release is correct and my child has permission to take part of all RMCT youth theater activities.
Parent or Legal Guardian (Print Name): ______________________________________________ Parent or Legal Guardian (SIGNATURE): ______________________________________________ Date signed: ______________________________________ RMCT PROGRAMS: PARENTAL PERMISSION AND LIABILITY RELEASE FORM I, _____________________________________, (parent’s name) as parent/ legal guardian of __________________________, (child’s name) hereby give my consent for participation in programs with Rocky Mountain Conservatory Theatre (RMCT). I assume all risks and hazards incidental to participating, and do hereby waive, release, absolve, indemnify, and agree to hold harmless Rocky Mountain Conservatory Theatre (RMCT), their staff, volunteers, program location venue, and any sponsoring agency for any claim arising out of loss or injury that the participant might sustain while engaged in this program. I understand that insurance is not provided and that none of the sponsoring agencies / lessees / lessors are responsible for the medical condition of the participant listed in the space provided above. Parent or Legal Guardian (Print Name): ______________________________________________ Parent or Legal Guardian (SIGNATURE): ______________________________________________ Date signed: ______________________________________ COVID-19 PUBLIC HEALTH ACKNOWLEDGMENT AND DISCLOSURE I understand that during the COVID-19 pandemic, I will need to respect the procedures in place for the safety of all persons present in our facility. I understand that to participate in all RMCT Theatre Program, my child must be free from COVID-19 symptoms. If at any time during my child’s attendance any of the COVID-19 symptoms appear, my child will need to return home as soon as possible
Parent or Legal Guardian (Print Name): ______________________________________________ Parent or Legal Guardian (SIGNATURE): ______________________________________________ Date signed: ______________________________________ DEPOSIT TO RESERVE YOUR SPOT A deposit of $250 is needed to reserve your spot and is payable either by: -1- CHECK -2- CREDIT CARD/PAYPAL on our website at: https://www.youthactors.com/account-payments.html ANY QUESTIONS?
- EMAIL US: contact@RMCTonline.com - MAILING ADDRESS: RMCT/Rocky Mountain Conservatory Theatre, 170 NE 2ND Street, Suite 1806, Boca Raton, FL 33432 Sincerely, Anthony Hubert and staff Founder and Artistic Director Rocky Mountain Conservatory Theater |
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