Registration Form (One Per Child)
KidShine “Breakthrough” Registration Form 2016
*Cost: First child: $100 ~ Second child: $75 ~ Third child: $50 Cost includes snacks & t-shirt. Scholarship help is available on a first come, first served basis.
Contact the church office for more information (607) 734-1614.
*Camp size is limited to the first 45 registrants, so sign up today!
*Absence policy: We have a very full week, so it is important for all campers to attend camp every day, all day. If a camper misses rehearsal times required for his/her assigned part(s), those parts will be reassigned to someone else. We appreciate your understanding.
*Friday night performance: campers are asked to wear a solid black shirt (no printing or writing), dark jeans or pants, and sneakers or other soft-soled shoes (no flip-flops or Crocs, please).
* Register by June 1st to receive a $5 Barnes and Noble gift card.
You will receive this early registration prize on the first day of camp. (Please see back of this form for the picture of this item.)
*Mail Registration with $50 deposit per camper to: First Presbyterian Church, 1054 W. Clinton St., Elmira, NY 14905. (please make checks payable to First Presbyterian Church)
*Registration & full payment is due by June 15, 2016.
Camper Name / Date of Birth / Gender / School Grade –Entering Sept. 2016 / T-shirt Size (circle one)
B G / Youth S – M – L
Adult S – M - L
B G / Youth S – M – L
Adult S – M - L
B G / Youth S – M – L
Adult S – M - L
Name of parent/guardian(s): ______
Street address: ______
City: ______State: ______Zip: ______
Phone number: ______(cell/ home/ work)
Home church: ______
Allergies or other medical conditions:
______
In case of emergency, contact: ______
Phone number: ______Relationship to camper: ______
RELEASE: I hereby release & agree to hold harmless First Presbyterian Church of Elmira, KidShine, its leaders and volunteers of and from all liability for damage, illness, or injury. In case of emergency involving injury or illness, I give permission to order medical treatment. I also grant permission for use of my child’s photograph in promotional materials which may be produced by the First Presbyterian Church.Signature:______Date:______
*How did you hear about KidShine?______
UPDATE!
KidShine Camp is filling up quickly!
We are capping the number of registrations at 45 campers.
We highly recommend that you send your registration in as soon as possible!
A limited amount of scholarship help is still available.
KIDSHINE PERFORMING ARTS DAY CAMP!
JUNE 27 – JULY 1, 2016
MONDAY – FRIDAY 9:00 a.m. – 3 p.m.
For youth entering 3rd grade through 8th grade in the fall
Includes a free T-Shirt and daily Snacks
Final performance is on Friday, July 1 at 6:45 p.m.
Youth of all faiths are welcome!
First Presbyterian Church
1054 West Clinton Street, Elmira
(607) 734-1614
Register by June 1st and receive a $5…