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Summer Camp Workshop Registration Form

Parent/Guardian Information

First Name

Last Name

Primary Phone

Please enter digits only. Example: 1234567890

Secondary Phone

Please enter digits only. Example: 1234567890

Emergency Phone

Please enter digits only. Example: 1234567890

Alternate Drop-off/Pick-up

Will you have additional adults picking up or dropping off students other than the Parent/Guardian listed above?

Alternate Drop-off/Pick-up?

Alternate Guardian 1

Guardian 1 Relationship

Alternate Guardian 2

Guardian 2 Relationship

Summer Camp Workshop Registration Form

Student Information

Please complete the following information for the student you are registering. To register another student, sibling or same student for another camp, select "Add another registration" in the lower right corner of this section.

Student's First Name

Student's Last Name

Student likes to be called

Birth Date

Allergies

T-Shirt Size

Camp Enrollment

Select from the list of available camps below. Please note that all discounts have been applied. Please visit our website at https://geminitheater.org/summer-workshops/ for more information on pricing and discounts. To register another student, sibling or same student for another camp, select "Add another registration" in the lower right corner of this section.

I would like to register for

Early Bird Discount Applied

Tuition Fee

Early Bird Discount Applied

Required Deposit

To register another student, please select the "Add another student" link below.

Additional Information

Is there any information you would like us know about your child or teen that will help us make their experience easier? ( i.e. Medical condition; Disability; Neurodivergent; Shy; Energetic; as well as preferred pronouns) Please Note: This information is not required and will never affect your registration.

Additional Information

Program Information

Please complete the following biography information for the Summer Camp program. Please list the school and grade they attend, activities that they participate in and any shows or creative activities they have participated in.

School Attended & Grade

Experience

Activities

Consent / Recording

Waiver: Gemini Children’s Theater takes photographs during technical rehearsal and performance to display on a pre-show slideshow in the theater as well as to give cast photos to all campers. Some photos may be used for future marketing purposes of our education program. Images would be used on our website and email newsletters, as well as on our Facebook and Instagram pages. They are not sold, traded, or otherwise provided to any other parties for use and remain the sole property of Gemini Theater.

I consent to the above statement:

YesNo

I do not consent to:

Recordings: Camp shows are recorded by Gemini Theater staff and edited to share with families in digital format through Dropbox. These links are only sent to the emails on file for that camp week. It is at your discretion to share the link with family who was unable to attend the camp show.

Recorded Performance Format

Private LinkDVD

Summer Camp Workshop Registration Form

Payment Details

Please select the appropriate payment option below. For the "Payment Plan" option, final payment must be received one week prior to class start date.

Amount Due

Early Bird Discount Applied

How are you making payment?

Credit Card (Full Payment)Cash or Check ($50 nonrefundable deposit per student required)Tuition Assistance ($50 nonrefundable deposit per student required)Payment Plan ($50 nonrefundable deposit per student required)

Amount Paid Today

Full Payment

Amount Paid Today

Required Deposit

Balance Due

Amount Paid Now

For Connector Processing

Tuition Assistance Information

Please provide a brief narrative why you feel your child would benefit from participating in this class and a "Proof of Income" document. Documents may include: Page 1 of most recent 1040 Tax Form; Recent Paycheck Stub; SSI Letter; Legal Document stating income from government source.

Proof of Income Document

Document may include: Page 1 of most recent 1040 Tax Form; Recent Paycheck Stub; SSI Letter; Legal Document stating income from government source

Narrative

Billing Address

Street

City

State

Zip

5-digits only

Credit Card

First Name

Last Name

Card Number

Code

Payment and Cancellation Policies

Payment Policies
Cancellation Policy

I have read and agree to the updated payment and cancellation policies.

IMPORTANT: Select the "Review Registration" button below to view your registration and make changes before you submit payment. You must select "Confirm" on the bottom of the next screen to process your application request.

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