Child's Name *

First Name

Last Name

Last Grade Completed by July *

Kindergarten

1

2

3

4

5

6

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Phone *

(###)

###

####

Child's T- Shirt Size *

Youth S

Youth M

Youth L

Adult S

Adult M

Adult L

Class Preferences *

Choose up to 3 (We will try to place each child within their preference, but cannot guarantee their first choice).

Beginning Piano

Culinary Arts

Guitar

Percussion/ Orff instruments

Sewing

Theater

Visual Art

Registration Fee Acknowledgement *

By checking this box, registrant acknowledges the $75 registration fee. This fee must be received before the start of camp to secure your spot. Please bring your payment to the church or mail it to : 4000 Brownsboro Rd Louisville, KY 40207

I understand that my child's registration is not complete until the $75 fee is paid before the start of camp

Digital Release Consent *

Photos will be taken during the week of camp. Do you give Broadway permission to use photos of your child for promotional use?

Yes, I give consent to use photos of my child for promotional use

No, I DO NOT give consent to use photos of my child