Summer Program Application Form

Summer Camp Application
PERSONAL INFORMATION
Student Name
First NameLast Name
Parent/Guardian Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Student Age
Student Birthdate
MonthDayYear
Student Email
example@example.com
Student Phone Number
Area CodePhone Number
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Area CodePhone Number
Grade in School Fall 2013
Where do you go to school?

TELL US ABOUT YOURSELF
To apply to the Summer Camp, please answer the following questions. There are no right or wrong answers to the questions – we’re simply trying to get to know you a little better. So feel free to answer the questions any way you would like.
What is your previous experience with performance, writing, filmmaking, playing music, dancing, painting, drawing, or making other forms of art? Please describe.
Pick a word to describe yourself and give us a few sentences about why you picked that word.
Tell us about a work of art you love. It could be a book you read, a play or movie you saw, song you listened to, or concert you went to. Why did you love it?
What other activities are you involved with on a regular basis? Tell us a bit about these activities and why you enjoy them.
How do you feel about performing?
How do you feel about writing?
Is there anything else you want to tell us about why you want to join us?

CONSENT
I release and waive, and further agree to indemnify, hold harmless or reimburse Challenge,Inc., the individual members, agents, employees and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the child's participation in the activities (including all forms of transportation) or the rendering of emergency medical procedures or treatment, if any.
Parent Signature
Should be Empty:

Summer Camp Application