Camper Full Name

Camper Nickname/Name They Prefer To Go By

Backup Guardian Phone

Current medications and dosage instructions (or "None")

Primary Care Physician Name & Phone

Photo/Video Release: I give permission for my child's image to be used for promotional and social media purposes.

Camper Birthdate DD/MM/YYYY

Parent/Guardian Full Name

Primary Guardian Phone

Guardian Email Address

Emergency Contact for Camper

Please include emergency contact: Full Name, Relationship to Camper, Phone Number,

Authorized Pickup

Please list everyone who is authorized to pick up camper. If they are allowed to leave by themselves, please note this.

Medical: Allergies

Please include all allergies or reply "none".

Medical conditions, access needs, or physical limitations (or "None")

I, the undersigned parent or legal guardian of the above-named minor participant, acknowledge that I am aware that participation in improv theatre camp activities ("the Activity") involves certain inherent risks, including but not limited to physical activity, movement exercises, stage performance, and interaction with other participants. I understand that these risks cannot be fully eliminated without compromising the educational and creative nature of the program.

I voluntarily consent to my child's participation in the Activity and assume all risks associated with such participation, whether known or unknown, foreseeable or unforeseeable, including risk of injury, illness, or property damage.

I agree to indemnify, defend, and hold harmless the Released Parties from and against any and all claims, damages, losses, costs, and expenses (including reasonable attorneys' fees) arising out of or related to my child's participation in the Activity.

In the event of an emergency, I authorize the Released Parties to seek and consent to medical treatment for my child if I cannot be reached in a timely manner. I understand that the Released Parties are not responsible for any medical costs incurred. I confirm that the medical information provided on my child's registration form is accurate and complete.

I understand that my child is expected to treat all campers, instructors, and staff with respect. I acknowledge that Lex Comedy Co. reserves the right to dismiss a camper from the program without refund if their behavior is deemed unsafe, disruptive, or harmful to others.

I understand and agree to the following refund policy: Cancellations made 14 or more days before camp begins: full refund minus a $25 administrative fee Cancellations made 7–13 days before camp begins: 50% refund Cancellations made less than 7 days before camp begins: no refund No refund will be issued for dismissal due to behavioral issues