Enrollment sheet for the 2009 summer sessions of the
Columbia Gorge School of Theatre
Mail completed application and payment to: CGST, 1381 Snowden Road, White Salmon, WA 98672, USA
You may also Fax (509-493-1501), or email (BlueMoon91@aol.com) the completed application and call in your credit card number (800-405-3450).
Contact Info: 1-800-405-3450 / 1-509-493-1213 / www.TheatreCamp.com / BlueMoon91@aol.com

The Basics

Student's Full Name:___________________________________________________________

Session Number: (1st Choice)____________ (2nd Choice)_____________T-Shirt Size________

Mailing Address: _____________________________________________________________

City/State/Zip: _______________________________________________________________

Phone Number(s): _____________________________________________________________

Nickname:______________Date of Birth: _____/_____/________ Age in Summer, '09_______

Fall, 2009 Grade Level:__________ Place of Birth: ___________________________________

Gender: _________ Parent email: ________________________________________________

Student email:_______________________________________School____________________

Please Attach Student Photo Here (including Alumni!)------>

Are you an alumnus? _____ What previous year(s)/session(s) did you attend?_____________

Parent/Guardian name:____________________________________ Work Phone Number: ______________________________________

Parent/Guardian name:____________________________________ Work Phone Number: ______________________________________

Parent Cell Phones: ____________________________________________________________________________________________

Alternative Emergency Name: ___________________________ Relation: ___________ Phone numbers: __________________________

Alternative Emergency Name: ___________________________ Relation: ___________ Phone numbers: __________________________

Are you an American Citizen? ______ If not a citizen of the US: Country of Birth__________ Country issuing passport_________________

How did you hear about CGST?_____________________________________________________________________________________

Medical Stuff

Insurance Company: _________________________ Group Number: _____________ Insurance Company Address: __________________

Name of insured ____________________ Relationship to participant ________ Insurance ID number _____________________________

Medication Allergies (list) _______________________________________________________________________________________

Food Allergies (list) _____________________________________Other Allergies (list) ______________________________________

Special eating requirements:______________________________________________________________________________________

Physician ________________________ Ph. ___________________ Dentist______________________ Ph. _____________________

Medications: Please list ALL medications (including over-the-counter or nonprescription drugs) taken routinely. Bring enough medication(s) to last the entire time at camp. Keep it in the original bottle that identifies the prescribing physician (if prescription drug), the name of the medication, the dosage, and the frequency of administration.

Please check one: ___ This person takes NO medication on a routine basis. ___ This person takes medication as follows:

Med #1 _____________________________ Dosage ___________ Time to be taken ____________Reason for med __________________

Med #2 _____________________________ Dosage ___________ Time to be taken ____________Reason for med __________________

Med #3 _____________________________ Dosage ___________ Time to be taken ____________Reason for med __________________

Please put parent initials next to each medication below that the student is allowed to take in recommended doses if they do not bring their own supply to camp (we might substitute generic versions):

Tylenol _________ Advil _________ Benadryl _________ Pepto Bismol_________ Cough Suppressant _________

What should the camp know about the camper's past medical treatments, behavior, physical, emotional or mental health?

____________________________________________________________________________________________________________

Immunizations, including Tetanus__________________________________________________________________________________

Theatrical History (It's okay if you don't have any experience.)

Plays/roles/name of theatre: _____________________________________________________________________________________

____________________________________________________________________________________________________________

Dance experience/training:_______________________________________________________________________________________

Singing experience/training:_____________________________________________________________________________________

Voice type (soprano, alto, tenor, bass, etc.)________________________________ Range (if known)___________________

Personal Information

What are your interests and goals in the theatre?________________________________________________________________________

____________________________________________________________________________________________________________

Why do you want to attend CGST? __________________________________________________________________________________

What are some of your hobbies, other than theatre?______________________________________________________________________

2009 Sessions (CIRCLE your 1st Choice and 2nd Choice)

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1 Week--Youth Workshop Age 8-11 June 29 - July 4 By Oct 31 $649/ By Dec 15 $699/ By Mar 15 $749/ After Mar 15 $799

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1 Week--Musical Theatre Age 11-18 June 29 - July 4 By Oct 31 $649/ By Dec 15 $699/ By Mar 15 $749/ After Mar 15 $799

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1 Week--TV/Film Workshop Age 11-18 June 29 - July 4 By Oct 31 $649/ By Dec 15 $699/ By Mar 15 $749/ After Mar 15 $799

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1 Week--Theatre Intensive Age 11-18 July 20 - July 25 By Oct 31 $649/ By Dec 15 $699/ By Mar 15 $749/ After Mar 15 $799

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2 weeks--Session 1 Age 11-18 July 6 - July 18 By Oct 31 $1475/ By Dec 15 $1525/ By Mar 15 $1575/ After Mar 15 $1625

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2 Weeks--Session 2-TV/Film Age 11 - 18 July 6 - July 18 By Oct 31 $1475/ By Dec 15 $1525/ By Mar 15 $1575/ After Mar 15 $1625

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2 Weeks--Session 3 Age 11 - 18 July 20 - Aug 1 By Oct 31 $1475/ By Dec 15 $1525/ By Mar 15 $1575/ After Mar 15 $1625

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4 Weeks--4 Week Session Age 11-18 July 6 - Aug 1 By Oct 31 $2939/ By Dec 15 $3009/ By Mar 15 $3079/ After Mar 15 $3149

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5 Weeks--Advanced Track Age 12-18 June 29 - Aug 1 By Oct 31 $ 3499/ By Dec 15 $ 3599/ By Mar 15 $3699/ After Mar 15 $3799

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Sessions 1 and 3 are identical. Call 800-405-3450 for questions about the sessions. To receive the Early Bird prices, you must pay 50% by the deadline.

If 50% down is a problem, payment plans can be arranged with Jan James, Executive Director.

Tuition: $___________ Includes meals, snacks, housing, supervision, tshirt, DVD, water bottle, 45 per week classes/rehearsals, field trip & theatre/film production.

Less Discount -$___________ 5% for alumni; $50 discount for enrollling with a friend(s).

PDX Pickup? +$__________ Will you need to be picked up at the Portland Airport (PDX)? $85 round trip or $60 one way (circle one).
Remember to email (BlueMoon91@aol.com) or fax (509-493-1501) your flight info ASAP.

Total Enclosed $___________ Minimum due 50%--balance due 30 days later unless arrangements are made with Jan James, Executive Director.
Pay by check, VISA, or MasterCard.

Credit card #_______________________________________________________________________Expiration Date_______________

Card Billing Address___________________________________________________________________________________________

The Legal Stuff - please read before signing!

We, the undersigned hereby declare that this enrollment sheet to the Columbia Gorge School of Theatre (CGST) is complete and accurate to the best of our knowledge. In signing this form, we acknowledge that we have read the policies of CGST, and agree to abide by them. Consent is hereby given for the applicant, while a student at CGST, to participate in radio and television programs, without compensation, and for photographs taken at CGST to be used in CGST - approved publicity. We understand and approve of the fact that students will be transported via cars, vans, and/or buses driven by CGST staff.

As participants in the activities contracted for or associated with CGST, I assume for myself, my family, including minor children, full responsibility for any injuries or damages which may occur to us while engaging in the contracted events and do fully and forever release CGST, its owners, employees and agents from any and all claims, demands, damages, rights of action or causes of action present or future, whether the same be known, anticipated, or unanticipated, resulting from or arising out of participation in any activity, or use of the facilities, equipment and property of CGST. I understand that I am solely responsible for all medical expenses incurred by me while enrolled in CGST. The above health history is correct and complete to the best of my knowledge, and the person herein described has permission to engage in all camp activities except as noted. I hereby give permission to CGST to order X-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for me/or my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for the person named above. Authority is hereby granted without limitation to the camp and its assigns to make decisions and/or authorize treatment of the above named camper with regard to all medical, surgical or dental matters that may arise while the camper is in the care of CGST including, but not limited to, all matters regarding hospitalization, surgery, injections, medication, and/or anesthesia. All campers must have medical insurance.

During the camp sessions, the camper and their parent(s)/guardian(s) agree to abide by the camp standards and guidelines. This includes the standards that campers may not smoke cigarettes, drink alcohol, use illegal drugs, engage in romantic contact, nor engage in any other inappropriate behavior while attending CGST. Failure to follow the rules of CGST is grounds for expulsion without refund. Any extra expenses incurred after expulsion will be the responsibility of the parent(s) or guardian(s). CGST is not responsible for lost or stolen items.

Each student must send at least 50% payment with this application. The balance will be due in 30 days, unless your session starts in less than 30 days. If you are unable to pay 50% with this application, monthly payment plans can be arranged with Jan James, Executive Director at BlueMoon91@aol.com or 800-405-3450. Should you wish to change the session you're enrolled in, we must charge a $25 processing fee.

Refund policy: 90+ days before camp starts: 50% of total tuition. 60 - 89 days before camp starts: 50% of total tuition. 30 - 59 days before camp starts 25% of total tuition. Less than 30 days before camp starts: 0% of total tuition. Please note that at CGST we encourage hugs, though they are always optional. We understand that Linklater Voice class includes optional, supervised massage work. We enthusiastically wish to enroll the above named student, and look forward to having a great summer!

Parent/Guardian Signature_______________________________________________________ Date______________________

Student Signature______________________________________________________________ Date______________________

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