On The Road to Peace

Summer Peace Arts Theatre Camp Registration Form (Please submit one form for each student attending)
Student's Name:
Age:	Grade:
Student is attending:   Session One     Session Two
Parent/guardian name(s):
Address:
Telephone:	Cell Phone:
Email:
Emergency Contact:
Telephone:	Cell Phone:
$75 per child is the cost for children of parents/guardians with an income under poverty level. $100 - $200 per child is the cost for children of parents/guardians over the poverty level. If fully employed, please choose the high range! Full Tuition Scholarships & Volunteer opportunities are available. Yes! I realize my tuition doesn't cover the full costs of the Peace Arts Camps. Here is my tax-deductible donation of $ ___________ and/or recurring monthly of $ __________ Enclosed is my check to BroadArts Theatre for $ _________ I will pay $_______ online at www.broadarts.org by credit card. Mail this form to: BroadArts Theatre, P.0. Box 13370, Portland, OR, 97213-0370 Questions? Call us at (503)287-0100
Scholarships and Volunteer Opportunities
I'd like to volunteer to assist the Peace Arts Camp staff for:           one day mornings afternoons. I'd like to apply for a full scholarship for my child.           In exchange, I can assist the Peace Arts Camp staff on:           Mon   Tues   Wed   Thurs   Fri   All week

Cancellation Policy: We understand that emergency situations and unexpected events arise. If you need to cancel your registration before July 17, 2009, you will receive a full tuition refund (minus a $20.00 registration fee). Please note that Cancellations after July 17, 2009 cannot be refunded and that there is no refund for any day your child is absent from camp.