Columbia Gorge School of Theatre - Online Enrollment Form

Enrollment Form

Please complete the entire form below.
Online applications must be completed in full before submitting, or the form
can not be accepted. Thank you!

Please call Jan James at 800-405-3450 with payment information.
We accept Visa or MasterCard.

Student's Full Name:
1st Choice:
2nd Choice:
T-Shirt Size
Mailing Address:
City, State ZIP:
Phone Number(s):
Nickname:
Date of Birth (mm/dd/yyyy)
Age in Summer:
Fall Grade Level:
Place of Birth:
Gender:
Parent email:
Student email:
School:
Student photo:
Are you an alumnus?	, Year(s):
Parent/Guardian name:
Work number:
Parent/Guardian name:
Work number:
Parent Cell Phones:
Alternative Emergency Contacts
Name:
Relation:
Phone numbers:
Name:
Relation:
Phone numbers:
Other
Are you an American Citizen?:
Non-US country of birth:
Country issuing passport:
Work number:
How did you find out about us?
Medical
Insurance Company:
Group Number:
Insurance Company Address:
Name of insured:
Relationship to participant
Insurance ID number
Medication Allergies
Food Allergies
Other Allergies
Special eating requirements:
Physician
Phone
Dentist
Phone
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.

	This person takes NO medication on a routine basis.
	This person takes medication as follows
Med #1: Dosage: Time to be take: Reason for med: Med #2: Dosage: Time to be take: Reason for med: Med #3: Dosage: Time to be take: Reason for med:
Please check 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 Plays/roles/name of theatre: Dance experience/training: Singing experience/training: Voice type (soprano, alto, tenor, bass, etc.) Range (if known)
Personal Info 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?
Sessions (choose two)	Pricing
1 - Youth Workshop 1 week	Age 8-11, June 24-29 By Oct 31, $699 By Dec 15, $719 By Mar 15, $739 After Mar 15, $759
2 - Acting Workshop 1 week	Age 11-18, June 24-29 By Oct 31, $699 By Dec 15, $719 By Mar 15, $739 After Mar 15, $759
3 - Musical Theatre Workshop 1 week	Age 11-18, June 24-29 By Oct 31, $699 By Dec 15, $719 By Mar 15, $739 After Mar 15, $759
4 - Two Week Session 2 weeks	Age 11-18, July 1-13 By Oct 31, $1629 By Dec 15, $1679 By Mar 15, $1729 After Mar 15, $1779
5 - TV/Film Session 2 weeks	Age 11-18, July 15-27 By Oct 31, $1629 By Dec 15, $1679 By Mar 15, $1729 After Mar 15, $1779
6 - Four Week Session 4 Weeks	Age 11-18, July 1-27 By Oct 31, $3239 By Dec 15, $3309 By Mar 15, $3379 After Mar 15, $3449
7 - Advanced Track Session 5 Weeks	Age 11-18, June 24 -July 27 By Oct 31, $3739 By Dec 15, $3809 By Mar 15, $3879 After Mar 15, $3949
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, monthly payment plans can be arranged with Jan James, Executive Director. Please call Jan James at 800-405-3450 with payment information. We accept Visa or MasterCard.
Tuition Enclosed:	Includes meals, snacks, housing, supervision, t-shirt, DVD, water bottle, 45/week classes/rehearsal, and theater/film production.
Less discount:
PDX pickup:	Will you need transportation from the Portland Airport (PDX)? $85 round trip, $60 one way Remember to email your flight info at least 2 weeks prior to camp.
Total Enclosed:	Minimum due 50%. Balance due in 30 days unless monthly payment arrangements are made with Jan James. Call your VISA or MasterCard number in to Jan James, Executive Director, 800-405-3450
Legal Info 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. CGST is not responsible for lost or stolen itens. 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). 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!