Original Works Performance Camp (ages 10-13)

Camper Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * DOB:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• *

  Gender:

  • M
  • F

• Fee

  Type	Fee
  Event fee	$100.00

Additional Camper Information

You may add a maximum of 5

Parent Information

• * Parent Name:
• * Parent Phone:
• * Where did you hear about this event? (Please be as specific as possible)
   characters remaining
• *

  Is text messaging a good way to contact you using this number?

  • Yes
  • No
• * Parent's Employer (for grant purposes)
• * Parent's Employer (for grant purposes)
• *

  I understand that tuition for this camp must be paid in full one full week prior to the start date of this camp, or I will forfeit my participation in this camp.

  • yes
  • no

Custom Information 1

• * Age of child at the start of camp
• * What School does the child attend?