Educational Programs for Youth
Raleigh Ensemble Players Theatre Company
REGISTRATION FORM
Please complete the form and mail it along with payment to REP at 213 Fayetteville Street,
Suite 202, Raleigh NC 27601.
Student Name: _________________________________________ Age: _____
Address: _______________________________ City: ___________ State: ___ Zip: _______
2009/10 Grade: _______ Gender: ___ Male ___ Female
Mother / Guardian: ____________________________________________________________
Contact Phone – Daytime: _____________ Evening: _____________ Cell: ______________
Father / Guardian: _____________________________________________________________
Contact Phone – Daytime: _____________ Evening: _____________ Cell: ______________
Email(s): _____________________________________________________________________
Person(s) Authorized to Pick Up Student: _________________________________________
Emergency Contact (if primary contact can not be reached):
Name: _________________________________ Phone: _______________________________
Is there anything we should know about the Student? (Health, Allergies, Needs, etc.)
____________________________________________________________________________
____________________________________________________________________________
Lunches: Campers should bring a bag lunch and beverage with a cooler pack. No refrigeration is available. Lunch time will be supervised.
Drop-off and Pick-up:
For Week-Long Experiences, doors open at 8:30am for drop-off. Pick-up is 4:30-5pm.
Late pick-up is available until 5:30pm for $25 per student per week.
For Weekend Experiences, doors open at 9:30am for drop-off. Pickup is 6-6:15pm.
No late pick-up available on weekends.
REGISTRATION
Choose your experience(s) below:
Week-Long Experiences—9am to 4:30pm daily
____ It’s Greek to Me July 13-17 (Rising 6th & 7th Graders)
____ Picture Perfect July 20-24 (Rising 7th & 8th Graders)
Each weekly experience is $200. Subtotal for Week-long Experiences: _________
Late Pickup: $25/week _________
Weekend Experiences—10am to 6pm
____ Know Thyself Saturday, July 11th (Rising 6th & 7th Graders)
____ DO Unto Others Saturday, July 18th (Rising 8th & 9th Graders)
Each weekend experience is $65. Subtotal for Weekend Experiences: _________
TOTAL: _________
Registration Deadlines:
It’s Greek to Me & Know Thyself: Wednesday, July 8th at 5pm
Picture Perfect & DO Unto Others: Wednesday, July 15th at 5pm
Cancellation / Refund Policy: Cancellations must be made in writing and may be sent by email. Cancellations made before the registration deadline will be entitled to a full refund less a $25 cancellation fee per experience. If cancellation occurs after the registration deadline, the cancellation fee is $50 per experience. No refunds on or after the start date of each experience.
PAYMENT:
_____ Check payable to REP enclosed.
_____ Charge my Credit Card (MasterCard or Visa only)
Card Number ____________________________ Exp Date: ____
Cardholder Signature: ___________________________________
PERMISSIONS & WAIVERS:
Field Permission: From time to time, campers will travel to locations on and around Fayetteville Street for camp-related activities, including Moore Square and Nash Square. As the undersigned parent or guardian, I grant permission for my child to leave the REP premises under the supervision of REP’s the [zu] staff.
Publicity Release: I hereby authorize and give consent to Raleigh Ensemble Players to publish and copyright any photographs in which my child appears while enrolled as a student at REP. Children will not be identified by name in photo captions.
Waiver of Liability: I hereby release Raleigh Ensemble Players Inc, its employees, board members, volunteers, landlord, and grantors from any and all liability, cost or expense associated with any injury I / my child may sustain while participating in the [zu] Educational Programs. I certify that there are no medical or other reasons why my child should not participate in this program.
Parent / Guardian Signature: ___________________________________ Date: ___________