Register

REGISTRATION
& Scholarship Info

THEATER IN THE WOODS VT CAMP 2022
WEEKDAYS
BEARS: ONE WEEK: June 27 - July 1 (ages 7-8)
BOBCATS: July 4 - July 15 (ages 9-11)
WOLVES: July 18 - July 29 (ages 12-16)

Tuition and Payment information

The tuition for two weeks of camp is $600*. Tuition for one-week Bears camp is $300.
This includes daily delicious snacks and lunch.
A deposit of $200 submitted with this form holds your place in the camp. We will accept installments of payments.
The balance is due June 24th, 2022 for Bears; July 1 for Bobcats; July 15 2022 for Wolves.

SCHOLARSHIPS AVAILABLE!

* If you are a Rutland County resident, you may apply to the Hayes Foundation for a needs-based financial grant to assist with the tuition. https://www.thehayesfoundation.org/individual-grants.html

!! IMPORTANT DEADLINE CHANGE: Hayes Foundation applications are no longer rolling but considered on a quarterly basis. The applications take three weeks for consideration. APRIL 1 and JUNE 1 are the pertinent deadlines for this camp, with decisions the third weeks of those months.

* If you live in Poultney, email us for information on scholarship assistance: theaterinthewoodsvt@gmail.com

* If you live in Tinmouth, you may apply to the Tinmouth Community Fund to assist with the tuition. The 2022 deadline is May 1.

* If you live in none of the above and need some assistance, write to us here: theaterinthewoodsvt@gmail.com

PayPal fees are added to online payment.
You can print the PDF form here and send it to us with your check to:
Theater in the Woods Vermont Co.
72 Sundog Lane, Middletown Springs VT 05757

QUESTIONS?
Call Melissa at 802-235-2050

tiw_registration_and_med_form_2022.pdf
File Size:	114 kb
File Type:	pdf

Download File

Online registration: fill the form below. Use PayPal or send us your check to the address above.

EMERGENCY AND MEDICAL RELEASE FORM

* Indicates required field

Camper's Name *

First

Last

Camper's age as of July 1 *

School and grade *

Camper's birth date *

Parent or guardian *

First

Last

Parent or guardian *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Phone Number *

Email *

Emergency Contact Information - three contacts are required:

Name *

First

Last

Phone Number *

Name *

First

Last

Name *

First

Last

Phone Number *

Please list those people in addition to parents/guardians who are permitted to pick up your child:

Alternate Pickup/Release *

MEDICAL RELEASE INFORMATION

INSURANCE POLICY NAME *

INSURANCE CONTACT Phone Number *

INSURANCE POLICY ID # *

Primary Physician Name *

Primary physician address *

Phone Number *

Please list any medical problems, including any that require maintenance medication (i.e. diabetes, asthma, seizures) *

Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason? No/Yes. If Yes, explain: *

Is your child allergic to any type of food or medication? No/Yes. If Yes, explain: *

Does your child require a special diet? Yes/No. If YES, explain: *

Please list any other allergies (insects, seasonal/environmental, animals, asthma); describe reaction and management: *

Does your child need an EPI-Pen? No/Yes. If Yes, describe type of allergic reaction, including signs and symptoms of distress: *

Any medication to be self-administered or given by us at camp? Please specify by a written doctor's order with Name of drug and Dosage Frequency *

By checking these boxes below, I hereby give permission to give my child over the counter medications according to standard dose:

Tylenol *

Ibuprofen *

Benadryl *

Other, Please specify *

The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.

Does your child have any special needs - medical, emotional, learning? Provide as much detail as possible. *

Please indicate (or call us at 802-235-2050) any situations inside or outside of camp that may affect your child's behavior: *

RELEASE FORM

The majority of Theater in the Woods activities take place outside, with exposure to risks normal in outdoor activity. We will safeguard against normal foreseeable risks. At the same time, accidents can occur during the everyday course of events, and it is impossible for us to insure ourselves adequately against such occurrences. Therefore we ask you to take responsibility for providing adequate health insurance for your own child, and that you sign a waiver agreeing to indemnify us for any medical expenses. Your insurance information provided above enables reimbursement to be made for any medical care needed by your child in the duration of our day camp. In case of an emergency, and if a family physician cannot be reached, by checking the box below I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).

Check Box *

I have read and agree to the terms above.

By checking the box below, I agree to hold Theater in the Woods Vermont blameless for any accident or injury which may occur to my child during the course of the camp, except in the case of gross or willful negligence, and I agree to indemnify Theater in the Woods Vermont against medical claims which may arise from my child’s illness, accident or injury.

Check Box *

I have read and agree to the terms above.

PHOTOGRAPHY and TRANSPORTATION

I hereby give permission for my child to be photographed during Theater in the Woods Camp. I understand the photos will be used to keep a journal of activities, to share in reports to our supporters, and for promotional purposes including flyers, brochures, and on the internet. I understand that although my child's photograph may be used for advertising, his or her identity will not be disclosed. *

I hereby give permission for the transportation of my child for Theater in the Woods activities by modes of transportation agreed to by the camp directors. *

TUITION PAYMENT

Select One *

Tuition for Bobcats or Wolves camp is $600. Tuition for one-week Bears camp is $300. I agree that I will use the payment button below to pay the full fee or a deposit of $200 upon submission of this form. I agree that I will pay the balance of $400 due by July 1, 2022 for Bobcats' camp or by July 15, 2022 for Wolves' camp, or the balance of $100 for Bears' camp by June 24, 2022. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. *

I agree to the tuition payment terms.

Electronic Signature *

First

Last

Submit

YOU WILL KNOW SUBMISSION WAS SUCCESSFUL BY A MESSAGE SAYING SO ABOVE THIS LINE.
IF YOU DO NOT SEE THAT MESSAGE, SCROLL UP TO SEE WHAT REQUIRED BOX (OUTLINED IN RED) WAS MISSED.

If you choose to use PayPal, its fees are added to your registration.
You are very welcome to print out the PDF registration form and mail it to us with your check - no fees except your stamp!

TUITION PAYMENTS
Choose your option from the drop-down menu below before hitting the PayPal button.

Theater in the Woods Vermont Co.
72 Sundog Lane, Middletown Springs, VT 05757
theaterinthewoodsvt@gmail.com
802-235-2050

REGISTRATION & Scholarship Info

Tuition and Payment information

SCHOLARSHIPS AVAILABLE!

EMERGENCY AND MEDICAL RELEASE FORM

REGISTRATION
& Scholarship Info