Stray Pups Youth Theatre

Summer Camp 2026

Enrollment Form

STUDENT’S INFORMATION:

Student Legal First Name

Student Legal Last Name

Student Preferred Name

(as their name should appear in the Production Program)

Student Preferred Pronouns

PARENT/GUARDIAN INFORMATION:

Primary Guardian

Phone

Relationship to student

Secondary Contact

Phone

Relationship to student

ADDITIONAL EMERGENCY INFORMATION:

(in addition to Parent/Guardian)

Emergency Contact

Phone

Relationship to student

Emergency Contact

Phone

Relationship to student

ADDITIONAL STUDENT PICK-UP INFORMATION:

(in addition to Parent/Guardian/Emergency Contact- must be 18+ & approved by Director)

Pick-Up Contact

Phone

Relationship to student

Pick-Up Contact

Phone

Relationship to student

MEDICAL CARE INFORMATION:

(Parents/Guardians will be notified immediately in any case of accident or illness. STRAY DOG THEATRE will utilize this information only if the child is requiring immediate medical care.)

Doctor/Clinic Name

Physician

Phone

Address

Hospital

Physician

Phone

Address

ALLERGIES, MEDICATIONS, AND HEALTH ISSUES:

NOTE: write "N/A" for any fields below that do not apply

LIST OF ALL ALLERGIES

(Be sure to include allergies to detergents, latex, adhesives, medications, food, seasonal/environmental, etc.)

LIST OF ALL MEDICATIONS

LIST OF ALL AND HEALTH ISSUES

(Include any behavioral or learning support needs on paperwork so we can anticipate child’s needs)

AUTHORIZATIONS:

I grant permission to STRAY DOG THEATRE to photograph and film my child in participation in STRAY PUPS YOUTH THEATRE. I understand that STRAY DOG THEATRE may use photographs or video of my child for documenting, marketing, and reporting purposes. I agree to waive all rights, royalties, and restrictions for such use.

Parent/Guardian Signature

By typing my name above, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

Date

Month

Day

Year

I agree to have my child exercise care and diligence while participating in STRAY PUPS YOUTH THEATRE and heed all instructions given to my child related to safety and procedures in and around the performance venue. I am aware of potential risks associated with rehearsals, preparations, and performances of live theatre. I agree to hold harmless and waive any claim or action against STRAY DOG THEATRE and its staff from any liability, fault, or action arising from my child’s participation.

Parent/Guardian Signature

By typing my name above, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

Date

Month

Day

Year