<p>2016 – GPLT Rising Star Summer Drama Camps Registration Limited spots available – register soon! Phone: 538-1616 Fax: 532-0464 Email: [email protected]</p><p>#1) Camp One- July 4-8 (ages 7-10) #5) Camp Five- August 2-5 (ages 7-10)</p><p>#2) Camp Two- July 11-15 (ages 11-14) #6) Camp Six- August 8-12 (ages 11-14)</p><p>#3) Camp Three- July 18-22 (ages 7-10) #7) Camp Seven- August 15-19 (ages 7-10)</p><p>#4) Camp Four- July 25-29 (ages 11-14) #8) Camp Eight - August 22-26 (ages 11-14) </p><p>*Please Note: Free public performances are at 4:00pm on Friday for each camp.</p><p>Camp hours are 9am to 3:30pm Supervision available 8:30am to 4:00pm Cost: 5-day Camps $260 Camps 1, 3, 5 and 7 are for students 7-10 years 4-day Camp (#5) $208 Camps 2, 4, 6 and 8 are for students 11-14 years Comfortable clothing and clean shoes are required Students must bring a lunch and a water bottle</p><p>Student Name Age Grade Camp #’s (please circle)</p><p>______1 2 3 4 5 6 7 8</p><p>______1 2 3 4 5 6 7 8</p><p>______1 2 3 4 5 6 7 8</p><p>Parent/Guardian Name: ______E-mail: ______</p><p>Phone (h):______(w):______</p><p>Address: ______PC: ______</p><p>Comments / Allergies / Health Concerns: ______</p><p>Payment: CASH CHEQUE VISA MC DEBIT</p><p>______/____ TOTAL: $ ______PAID: Y / N Card# exp.</p><p>Full refund will be issued if cancellation is received a minimum of 14 days prior to the camp start date. After such date, there will be NO REFUNDS or REIMBURSEMENTS given for camps. Only exchanges for other camps will be permitted.</p><p>Freedom of Information and Privacy (FOIP) Consent and Liability Waiver</p><p>I am the parent or legal guardian of ______. I know there is a risk of physical injury from this activity and I give my informed consent to this student taking part in the classes and the Friday performance. I know the organizers are not responsible for any belongings of my child. I release Grande Prairie Live Theatre and the GPLT Rising Star Summer Drama Program, the instructors and all members and employees of these organizations from any and all liability for injury or loss howsoever caused and suffered by this student or myself and caused directly or indirectly by this student’s involvement in these activities. As per the Freedom of Information and Privacy Act, I agree that photographs, video of the student and/or other promotional tools may be used by GPLT.</p><p>This consent, release and waiver of liability is signed at Grande Prairie, Alberta:</p><p>______date signature of parent / legal guardian</p>