Summer 2015 JUNIOR CAMPER Application Form
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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.
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What other experiences or volunteering will make you a good Junior Camper?
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What do you want to learn from your experiences as a Junior Camper?
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Identify two references (name, description of relationship, phone number).
1.____________________________________________________________________________
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2.____________________________________________________________________________
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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)
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Applicant Signature Date
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Applicant Name (printed)