Mainstage Center for the Arts
1 DAY PERFORMING ARTS CAMP -Martin Luther King Day
Registration is quick and easy. Complete the form below and continue to the payment page to pay with a credit card. You can also print the completed form and mail it to: Mainstage Center for the Arts, 27 S. Black Horse Pike, Blackwood, NJ 08012. OR drop your registration and payment off at Academy Hall, 27 S. Blackhorse Pike, Blackwood, NJ Monday through Thursday 4:00 - 8:00 pm. Checks can be made payable to Mainstage Center for the Arts.
The performing arts camp programming will run from 9:00 - 4:00 and will cost $50. Before care (7:30 - 9:00) and after care (4:00 - 6) is an additional $10. flat rate regardless of the hours of additional supervision is needed. There is a $3 base fee for online payments.
Items with an * are required.
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Additional Emergency Contact Cell
Guardian Email #1
Guardian E-mail #2
Programs and Payment
THE PERFORMANCE WORKSHOP SECTION OF THESE ONE DAY CAMPS RUN FROM 9:00 - 4:00 PM AND IS $50. YOU CAN ALSO REGISTER FOR BEFORE (7:30 - 9:00) AND OR AFTER CARE (4:00 - 6:00) FOR A FLAT FEE OF $10. INCLUSIVE
Please check off all appilcable comments:
I would like to register my son/daughter for One Day Camp on Monday, January 16th.
I would like to register my son/daughter for before and or aftercare on Monday, January 16th.
Check All That Apply
Gotta a Coupon Code?
GREAT JOB! YOU JUST SAVED $10.00.
$1O. Early Bird Special
If you are registering for before/aftercare please check off all applicable comments.
My son/daughter will need before care (7:30 - 9:00)
My son/daughter will need after care (4:00 - 6:00)
A description of the section goes here.
In case of an emergency, and guardians can not be reached, please call.
Relationship to family
Emergency Contact #:
Name of Doctor
Doctor's Phone #
Insurance Carrier and number
Pertinent Information you feel we should have to help insure your child's safety.
Parent of Guardian Signature
Privacy Photo Release
Please be advised that by its nature, a stage production will have photos taken by Mainstage and perhaps media outlets. We can assure you, however, that Mainstage will not associate an image of you or your child with their name, unless we have permission from you to do so. I grant Mainstage Center for the Arts and their representatives the right to use my Child's photographs or photographs of myself, and videos taken during classes, rehearsals, and productions during the 2016/2017 season. I authorize Mainstage Center for the Arts to use and publish the same in print and/or electronically. I agree that Mainstage Center for the Arts may use such photographs and video without my name attached, and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, social media, and Web content.
Studio Classes at Mainstage Center for the Arts
I hereby irrevocably release and forever discharge Mainstage Center for the Arts, its trustees, employees, agents, successors and assigns, and representatives from all and any liability by the taking/or publishing of any photograph, video tape, record, interview, statement or image of me or my child, as authorized in this consent form.
I warrant that I am of full age and have every right to contract in my own or my child’s name and that I am fully familiar with the contents of this authorization and consent.
By placing a check mark below this authorization and consent form, I hereby waive any right to compensation for the stated uses and I acknowledge that I have read and understand the above and agree to the terms of this Consent and Release
I have read and agree to the terms of this release.
RETURNED CHECK POLICY: ALL CHECKS RETURNED BY YOUR BANK WILL BE SUBJECT TO A $35 RETURN CHECK
CHARGE. RETURNED CHECKS MUST BE REPLACED WITH A CERTIFIED CHECK, CASHIERS CHECK OR MONEY ORDER AND MUST INCLUDE THE ADDITIONAL CHARGE.
Please let us know how you learned of our ONE DAY CAMP.
Do Not Fill This Out