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YOUTH THEATER CAMP

>45 Minutes from Broadway
by George M Cohan Adapted by June Walker Rogers
Presents
2013 Youth Musical Theater Program
Lead Instructor and Production Director: Scott White
Ages 7-17
July 29– August 9, 2013
Registration Fee: $125 (includes a camp t-shirt). Space is limited. Availability is first-registered, first-served
Auditions for lead parts in the musical will be Saturday, July 27th
10 a.m. to 1 p.m. at the Fox Theatre in Downtown Centralia. Prepare one song to be sung a capella.
Day Camp at Evergreen Playhouse: Monday-Friday, July 29th – August 9th, 10 a.m. – 3 p.m.
Performances at the Evergreen Playhouse August 10th at 2 p.m. & 7 p.m.; August 11th at 2 p.m.
Dress rehearsal August 9th at 3 p.m.
Lunch is not provided, please send your camper with a packed lunch and snack each day and bottled water. Campers will
experience professional instruction in all aspects of musical theater including dancing, acting, singing, set building/painting,
lighting, costuming and more!
Camp will conclude with three performances of the show. Performance tickets will be $6.
(Each camper will receive two complimentary tickets to the performance with registration.)
“45 Minutes
from Broadway”
Return the attached registration form to
Evergreen Playhouse
Youth Musical Theater
226 W. Center, Centralia, WA 98531
For questions please call Kelli Erb at caseyon2nd@aol.com
or visit the Evergreen Playhouse online at
http://www.evergreenplayhouse.wordpress.com

SIGN UP FORM!
Mail registration form and payment ($125) to:
Evergreen Playhouse
226 W. Center Street, Centralia, WA 98531
Children’s Theatre Camp and “45 Minutes from Broadway” Performance
Registration Form
NAME______________________________________________________AGE_______ GENDER______________
PARENT/GUARDIAN___________________________________________________________________________
PHONE_______________________________________________________________________________________
ADDRESS:____________________________________________________________________________________
EMAIL: ______________________________________________________________________________________
EMERGENCY CONTACT:_______________________________________________________________________
T-Shirt Size:
Youth Small ( ) Youth Medium ( ) Youth Large ( ) Adult Small ( )
Adult Medium ( ) Adult Large ( ) Adult X-Large ( )
Additional t-shirts available for purchase for $20 each. Number of Shirts_ ______ Size(s) _____________________.
Waiver/Release & Indemnify Agreement:
It is hereby understood & agreed:
1) I, the above signed parent/guardian, understand that this program involves physical activity, exertion, and some
physical contact and that participation in any of the activities potentially may result in serious injury arising out of conditions
of the facility utilized, player conduct, equipment utilized, and other factors, including random chance.
2) Evergreen Playhouse and the Fox Theatre and its owners, operators, volunteers, and agents are hereby released from
any and all claims for injuries or damages which may occur to above participants of this program whether such injuries
or damages are foreseen or unforeseen. It is further understood and agreed that the above signed agrees to defend, hold
harmless, and indemnify Evergreen Playhouse and the Fox Theatre from any claim by the participant, the participant’s
family, estate, heirs or assigns.
3) The parent/guardian signed is of lawful age and legal competent to sign this affirmation, release, hold harmless and
indemnify agreement.
PARENT/GUARDIAN NAME_ ___________________________________________________________________
SIGNATURE_ ________________________________________________DATE____________________________
If you are registering multiple children, please list their name, age and gender below. Only include these children on
this same form if they are under the same care/guardianship of the parent/guardian listed above and dwell in the same
household:
NAME:_________________________________________________________AGE __________GENDER ________
NAME:_________________________________________________________AGE __________GENDER ________
NAME:_________________________________________________________AGE __________GENDER ________
CANCELLATION POLICY:
Anyone wishing to cancel out of participation must provide written cancellation 48 hours prior to first day of camp.
Registrants who “no show” will not receive a refund. Medical emergencies require a doctor’s note and are up to the
discretion of the playhouse.

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