Little theatre... big heart 

DLT Junior Players Summer Camp Registration

Student’s Name: ______________________________________________
Parent or Guardian: ____________________________________________
Address: ____________________________________________________
Home Phone: ____________________ Cell Number: ___________________
Parent’s Email: ________________________________________________
Emergency Contacts:
Phone#: ___________________________________________________________
Please list any health concerns or allergies: ___________________________
If your child has any other condition that will need to be managed, while at
camp to ensure your child’s safety, please explain on the back of this form.
I grant permission for my child to be photographed for publicity purposes. I
understand that these photographs and my child’s name may appear in the
newspaper, future publications, and/or on the theater website.
Additionally, I understand that participation in a theater production requires
that my child be at all scheduled rehearsals and all shows associated with
those rehearsals.
Signature: __________________________________ Date: ______________
Printed name: ___________________________________________________
Fee Paid: _________ Check # ____________ Cash ____ Date: ____________
Please make checks out to Junior Players and send to: 

Reesa Jenkins
523 Mt. Hope Ave.
Dover, NJ 07801