CAMP ENROLLMENT

All forms must be emailed to info@flctstar.org in order to to be recorded in order of receipt. Any other delivery method may delay your order in the enrollment queue.

In-person camps are capped at 10 students per session until further notice (may increase later).

Enrollment is first come, first served. Upon receipt of your enrollment forms, you will be informed if you secured a spot and you will only be charged if you do.

If you do not secure a spot, you will be given the opportunity to join the waitlist, select a different session, or opt to do online camp (certain grades only).

If you are applying for a scholarship, please indicate that on your enrollment form. Please complete the scholarship application as soon as possible but you do not need to turn it in with the enrollment form. The completed enrollment form is your “place in line.” Scholarships are limited and are first come first served. A scholarship wait list will be maintained for each session after all scholarship funds are allocated.

Additional forms and waivers will be required and will be provided before the start of camp.

Any public location where people are present provides an inherent risk of exposure to COVID-19, an extremely contagious disease that may have serious health consequences. By attending programming at Florida Children’s Theatre, you voluntarily assume all risks related to exposure to COVID-19.

See www.flct.org for camp program details and additional COVID-19 information.

Sessions 1and 2 of In-Person Theatre Camp (grades 2-10) and Weeks 1-5 of Storybook (pre-k-1st) are full. Email info@flctstar.org to join the waitlist. Other sessions have very limited spots left and may have filled up. You will be contacted upon receipt of your forms.

Summer Camp 2020 Enrollment FormReturn to Florida Children’s Theatre

Email preferred: info@flctstar.orgYou will be contacted to confirm your enrollment

or update your waitlist statusFor FLCT Use Only: T/D R’cvd ______________________

Personal Information

Student _________________________________

Entering Grade ____ Gender _______ Age ___

DOB ____________________ T-Shirt Size _____

School __________________________________

Parent 1 _________________________________

Parent 2 _________________________________

Please specify special circumstances(Guardianship, divorce, etc)

Billing Address ___________________________

City _________________________ State ______

Zip ______________ Address is Parent 1 _____ Address is Parent 2 _____

Parent 1 Phone __________________________

Parent 2 Phone __________________________

Student Cell ____________________________

Other Phone ____________________________

Parent 1 Email ___________________________

Parent 2 Email __________________________

Student Email ___________________________

Enrollment Information: Select Camp(s):(email info@flctstar.org for waitlist if full)

In-Person Theatre Camp(Campers entering grades 2-10)

$495 per session (50% non-refundable deposit required)

Full Session 1 (6/8-6/19) ___Session 3 (7/6-7/17)Full Session 2 (6/22-7/3) ___Session 4 (7/20-7/31)

In-Person Storybook Adventures Camp(Campers entering Pre-K to 1st grade, min. age 4)

$275 per week (50% non-refundable deposit required)

Full Week 1 (6/8-6/12) Full Week 5 (7/6-7/10)Full Week 2 (6/15-6/19) ___Week 6 (7/13-7/17)Full Week 3 (6/22-6/26) ___Week 7 (7/20–7/24)Full Week 4 (6/29-7/3) ___Week 8 (7/27-7/31)

Virtual Theatre Camp via Zoom(Campers entering grades 2-5 and 6-8)

$250 per session (50% non-refundable deposit required)Entering grade _____

___ Session 1 (6/8-6/19) ___Session 3 (7/6-7/17)___ Session 2 (6/22-7/3) ___Session 4 (7/20-7/31

Payment Information

Total Tuition: ________ Deposit: ________

___ Pay in Full ___Pay Deposit Only___ Applying for scholarship (FLCT will contact you with deposit and balance amounts due)

Full payment due by Friday preceding first day of camp.

Please add an additional donation of $_______

Payment Method (choose one):Credit Card Authorization Form Attached ______or Please call me to pay over the phone _______or Please call me to arrange for cash or checkpayment ______or Scholarship Application pending ______

(allinformationrequired) Student’s Name: Payment for: Class/Camp Tuition Production Fee Tickets (Circle all that apply)

Production Extras Production Ad Donation

Other____________________________________________

(allmajorcreditcardsaccepted)

Cardholder Name: Card Number: Expiration Date: Security Code (3 digit code on back of card/4 on front of Amex): I hereby authorize . to charge my credit card for full payment of all charges incurred by me and/or my child(ren). Cardholder Signature: X Date:

Complete form and email, mail, or fax to:

2542B East Sunrise Boulevard, Fort Lauderdale, Florida 33304 Fax: 954-523-0507 Email: melanie@flctstar.org

HEALTH FORM 2019-2020

Date: ______________________

EMERGENCY CONTACT INFORMATION

Student Name: First MI Last

Emergency Contact:

First MI Last

Relationship: Home Phone:

Work Phone: ( ) – Mobile Phone: ( ) –

Physician Name: Phone:

1. Does the student have any health issues? (Check any that apply.)

None Diabetes Epilepsy Food Allergies

ADD/ADHD

Autism Spectrum Asthma Other: ____ _____________

If so, what special attention or considerations will she/he need?

2. Does the student have any allergies? No Yes:

If so, is treatment required? No Yes

If so, please list steps to take on how to administer treatment.

3. Is the student bringing any medication to class/camp?

No Yes

If so, please list all medication being brought to class/camp and proper administration guidelines.

4. Has the student had a tetanus booster in the last five (5) years?

No Yes

Print Parent/Guardian Name Parent Signature or Self if over 18

2019-2020 RELEASE, INDEMNITY, AND HOLD

HARMLESS AGREEMENT

I, the student named on the attached Enrollment Agreement, being sui-juris and above the age of 18 years…

OR

I, the parent or legal guardian of the student named on the attached Enrollment Agreement, hereby grant permission on behalf of myself, child, or ward, to…

…enter the program known as Fort Lauderdale Children’s Theatre conducted by Fort Lauderdale Children’s Theatre, Inc., presently located at 2542B East Sunrise Boulevard, Fort Lauderdale, Broward County, Florida, or at any other locations wherein the Theatre is located, or any other location where the Theatre is conducting its performances, and to furthermore participate in all classes, production or any other related activities to be held during the enrollment period.

The undersigned, individual or on behalf of said ward, do, by this instrument release and discharge the Fort Lauderdale Children’s Theatre, Inc., of and from all actions and costs of action, judgments, execution, debts, dues, claims, and demands of every kind and nature whatsoever which against the Fort Lauderdale Children’s Theatre, Inc., I/we ever had or now have or which our heirs, executors and administrators have now or may hereafter have by reason of any injury sustained to me or to any child or ward while on the premises described above or at any other location wherein the Theatre may be performing, due to the negligence of the officers, agents, servants, or employees of the Fort Lauderdale Children’s Theatre, Inc., including any injury or property damage sustained in any vehicle or by any vehicle while being used in transporting us to and from any assigned location.

Furthermore, in further consideration of the Agreement, I, the undersigned on my own behalf of my minor ward agree never to institute any suit or action at law or otherwise against the Fort Lauderdale Children’s Theatre, Inc., or its employees, servants, agents, officers, and officials; nor institute, prosecute, or in any way aid in the institution or prosecution of any claim, demand, action, or cause of action for damages, costs, loss of services, expense, or compensation for or on another of any damage, loss, or injury, either to person or property, or both as agents or employees of the corporation.

Furthermore, I further agree on my own behalf and on behalf of my minor ward that in the event the individual named on the enrollment agreement suffers any illness or accident requiring emergency hospitalization or surgery while at Fort Lauderdale Children’s Theatre, or any other utilized location, I hereby give my permission for any necessary hospitalization, medication, or surgery on recommendation of a medical doctor with the understanding that the staff or other representative of Fort Lauderdale Children’s Theatre will contact me at the earliest reasonable time.

Additionally, the undersigned agree to indemnify and hold forever harmless Fort Lauderdale Children’s Theatre, Inc. against any claim for damages, compensation or otherwise that may hereafter at any time be made or brought against Fort Lauderdale Children’s Theatre, Inc. or by anyone on our behalf for the purpose of enforcing a further claim for damages on account of any injury sustained herein.

I realize that there will be unanticipated and unexpected situations which may arise during these activities and I assume for myself and/or my child or ward, all risk of injury to our person and/or property that may be sustained in connection with the associated activities on or about the premises or at any other authorized location: I further certify that me or my child or ward’s attendance and participation in the stated activities is wholly voluntary and that we shall not in any way be considered as an employee, servant, or agent of Fort Lauderdale Children’s Theatre, Inc., its operators or sponsors. I have read and understood the foregoing release, indemnity, and hold harmless agreement and do attest and agree to same by my signature hereunder.

Student Name: First MI Last

Parent/Guardian Name: First MI Last

Parent / Guardian Signature (on behalf of minor / ward) or

Student Signature (if over 18 years)

Date

2020 Camp Refund Policy

1. If your child withdraws prior to a summer camp session commencing, the non-refundable deposit is forfeited. For any payment made above the 50% deposit, a refund will be given for that portion. If the parent/legal guardian prefers, a credit for the refund amount will be given valid for one year from the date of withdrawal

2. If your child withdraws from participating in a summer camp session after that session begins, the non-refundable deposit is forfeited. A credit will be given for the pro-rated value of the remaining summer camp (minus the deposit) your child does not attend. This credit is for future classes/plays and is good for one year from the date of withdrawal.

3. If FLCT is unable to offer a summer camp session as planned due to COVID-19 restrictions the following refunds/credits will be applied for cancelled sessions:

a. If a complete session is cancelled by FLCT, prior to that session commencing, a complete refund for the entire tuition, including the deposit, will be the issued. A credit good for one year may also be requested in lieu of a refund. If tuition was paid for multiple sessions, only the cancelled session(s) will be eligible for the full refund/credit.

b. If all the remaining days of a session are cancelled after the session has already commenced, a pro-rated refund will be issued only for the number of days remaining in that session. A credit good for one year may also be requested in lieu of a refund. If tuition was paid for multiple sessions, only the days remaining in the cancelled session(s) will be eligible for refund/credit.

c. If the start date of a session is postponed, a pro-rated refund will be issued only for the number of days skipped. A credit good for one year may also be requested in lieu of a refund. If a camper does not attend the partial session once it commences, the non- refundable deposit is forfeited and only the balance of tuition less deposit will be refunded (or credited by patron request).