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					                       SUMMER CAMP 2008 REGISTRATION FORM

                                Space is limited, and fills up fast!
                Mail in your registration and payment today to reserve your space.

Guided by POPS Summer Camp Directors, your child will be showcased in our summer camp demo, where
Musical Theatre meets a Talent Show! Please have students wear comfortable clothes and shoes that your
child can dance in…i.e. sneakers or jazz shoes. Students should bring a sack lunch daily, and snacks and
water will be provided by POPS.
Confirmation of registration will be sent via email once completed registration form and tuition payment
has been received. Only pre-registered students will be accepted. Please send registration form and
payment to:

Puttin’ On Productions                     (Please make checks payable to Puttin’ On Productions)
1206 Agate St. Suite B
Redondo Beach, CA 90277

Please check your camp choice:

CAMP 1 ___                  July 7 to July 11   (1 week)        $240.00
CAMP 2 ___                  July 14 to July 25 (2 weeks)        $475.00
CAMP 3 ___                  July 28 to August 1 (1 week)        $240.00

Form of Payment (please check): ____CHECK                  ____CREDIT CARD (Please fill out Credit Card
                                                                                         Authorization form)

1st Child’s Name __________________ Age ____ Allergies ____________________Fee______
2nd Child’s Name _________________ Age ____ Allergies ____________________ Fee______
3rd Child’s Name __________________Age ____ Allergies ____________________ Fee______

                Family Discount: 10% off of each additional sibling’s tuition!

                                                                                    TOTAL FEE______

Parent Name________________________                          Parent Name________________________
(Or Guardian)                                                  (Or Guardian)
Phone # 1 __________________________                         Phone # 1 __________________________

Phone # 2 __________________________                         Phone # 2 __________________________

I here by authorize the staff of Puttin’ On Productions to act for me with their best judgment in any
emergency requiring medical attention and I hereby waive and release Puttin’ On Productions from any and
all liability for injuries or illnesses incurred while at Hermosa Beach Playhouse with Puttin’ On
Productions. I have no knowledge of any physical impairment that would be affected by the above named
child’s participation in this program. I also understand Puttin’ On Productions retains the right to use for
publicity and advertising purposes, photographs of children taken at camp.

PARENT SIGNATURE: _________________________ DATE:______________________
                         Credit Card Authorization Form

Cardholder’s Name: _______________________________________________________

Address: __________________________________________________________

City: _____________________________ State: _____________ Zip: ______________

Telephone: (_________) __________-_________________

TOTAL: $ ___________________________

Payment applied to ________________________________________________________

Method of Payment: Discover, MasterCard, Visa
Card #: ____________________________________________CVV# _____________
Exp. Date: _______________________
Exact Name Printed on Card: _______________________________________________
CC Billing Address:

City: ___________________________ State: _____________ Zip: ______________

Signature _____________________________________ Date_____________________

OFFICE USE ONLY Approval #________________________________Date_____________________

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