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Please fill out this form to the best of your abilities. This form can be used to register your child for any of Auburn Public Theater's Summer 2023 camps. If you have any questions, you can contact Mo Allyn via email at molly@auburnpublictheater.org or leave them a message at (315) 237 - 2539.

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* 1. Child/Student Information

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* 2. What is your child's date of birth?

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* 3. Parent/Guardian Information

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* 4. Emergency Contact - Parent/Guardian #2 Information

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* 5. How did you learn about Auburn Public Theater's Summer Programs?

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* 6. Please list any medical conditions your child may have that you would like our staff to be aware of. 

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* 7. Please mark which camp(s) your child will be attending below.

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* 8. This year, we are proud to announce that we will be offering wrap-around care to all students; a class in the morning from 9AM-10AM, and a class in the evening from either 2PM or 4PM until 5PM. Please indicate if you would like to be contacted about our wrap around care program. 

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* 9. Please indicate if you would like to be contacted about scholarship options. 

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* 10. METHOD OF PAYMENT:

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* 11. Photo Release: I give Auburn Public Theater permission to use any photos taken of my child for promotional materials.

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* 12. Signature

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