Summer 2015 JUNIOR CAMPER Application
Summer 2015 JUNIOR CAMPER Application Form th Parents! We have a great opportunity for students entering 7 grade through high school. We have designed a program for these teens to get experience working behind the scenes for a show! Students will get a closer look into hair and make-up, stage design, prop design, costumes and how the sound system is run for a show as well. You must have attended Fine Arts Funanza previously in order to apply! We are looking for role models to become Junior Campers! STUDENT NAME: ______________________________________________________________ AGE: _______ DATE OF BIRTH: _________________ (Please Circle) MALE or FEMALE Please select Student’s t-Shirt size (circle one): Youth S Youth M Youth L Youth XL Adult S Adult M Adult L Adult XL HOME ADDRESS: ______________________________________________________________ CITY/STATE/ZIP: ______________________________________________________________ HOME PHONE: _________________________EMAIL:_________________________________ PARENT’S WORK PHONE: ________________________CELL:_________________________ MEDICATIONS TAKEN: _________________________________________________________ ALLERGIES: __________________________________________________________________ SPECIAL MEDICATION PROBLEMS: ______________________________________________ DATE OF LAST TETANUS SHOT: _________________________________________________ CHILD’S PHYSICIAN: _____________________________PHONE #______________________ MEDICAL INSURANCE CO.:________________________PHONE #______________________ POLICY #_____________________________________________________________________ Parent Signature______________________________ Date_______________________ Junior Camper Fee $60.00 (Includes T-Shirt, snacks and activity supplies) (Please make your check or Money Order Payable to Fine Arts Funanza) To finalize your registration please send “The Application Form” and “The Medical Consent Form” along with payment to: 288 Brandy Ridge Lane Dickinson, Texas 77539 Attn: Jacquelyn Silva/Fine Arts Funanza NOTE: Both send “The Application Form” and “The Medical Consent Form” must be completed, signed and received before the named participant can be assigned to the program. Please fill out the application below. The deadline is May 29th, 2015. We will send you an acceptance letter via E-MAIL by June 5th if you are chosen to attend the program. This year there will be limited room for each session for Junior Campers. Thank you for your interest in the program and we are looking forward to reading your application. Explain why you want to be a Junior Camper. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ What other experiences or volunteering will make you a good Junior Camper? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ What do you want to learn from your experiences as a Junior Camper? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Identify two references (name, description of relationship, phone number). 1.____________________________________________________________________________ ______________________________________________________________________________ 2.____________________________________________________________________________ ______________________________________________________________________________ You will earn hours that can go towards National Honor Society and other organizations. Please take your role as a Junior Camper serious. Please understand that you are a role model for younger students. Any questionable behavior during camp could end your role as a Junior Camper. Weeks I am interested in volunteering for Junior Camper (Please Check) June 22nd-26th June 29th-July 3rd July 13th-16th I am interested in volunteering with (Please Check) Decorating Stage Props and Scenery (Drawing, painting and creating scenery) Sound System and Lighting (Running the music and lights during the show) Backstage Management (moving sets and props during show) Hair and Make-up (For performance day) Costumes and Props (Preparing the props and organizing costumes for the show) I am able to attend Training on June 19th from 11am to 4pm (Manditory) ______________________________________________________________________________ Applicant Signature Date ______________________________________________________________________________ Applicant Name (printed)
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