The Curious Place Theatre Workshop Registration

Curious Place Workshops- Winter*

Homeschool Jan 10-Feb 28, 2023 At Spruce Peak Arts
Studio School Jan - June, 2023 at The Current

Be sure to complete the payment information as well.

Student Name*

First Last

Age*

Grade 2022/23*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Parent/Guardian Name*

First Last

Primary Email*

Enter Email Confirm Email

Primary Parent/ Guardian Phone (primary #)*

Primary Parent/ Guardian Phone (second #)

Primary Parent/Guardian Relationship to Student*

Emergency Contact (other than Primary Parent/Guardian)Name*

First Last

Emergency Contact Phone*

Emergency Contact Email

Emergency Contact relationship to student*

I give Spruce Peak Arts permission for emergency contact to pick up my child.*

Yes
No

Please list below any adults that have your permission to pick up your child :*

Does your child have any allergies, medications or special health needs?*

Yes
No

Students who would be on an IEP needing one-on-one support, must provide their own aide.

If yes, please explain....

Consent for medical care: I understand fully that even after responsible precautions have been taken, class activities may involve hazards for which Spruce Peak Arts cannot be held responsible. In the event that my child become ill or injured during time at Spruce Peak Arts, I authorize staff to seek emergency care.*

I agree to seek medical care if necessary.

Medical Insurance*

I certify that my child is covered by health and accident insurance or Medicaid and that in the unlikely case of an accident, Spruce Peak Performing Arts Center can share the name of the carrier and the policy number with health care provider provided.

Name of Carrier	Policy Number

I give Spruce Peak Arts permission to use a camper’s photograph or other media for display on the Spruce Peak Arts website or inclusion in Spruce Peak Arts publications.*

Yes
No (we respect your wishes if you do not grant permission)

T-shirt Size*

What size t-shirt does your camper wear?

Youth-Small
Youth-Medium
Youth-Large
Youth-X Large
Adult- X Small
Adult- Small
Adult- Medium
Adult- Large
Adult -X Large

Is there anything else we should know about your child to make this experience successful?

Thank you for registering!

Name

This field is for validation purposes and should be left unchanged.

Spruce Peak Arts Theater Workshop