Jesse Cline, Artistic Director 
104 East State St. Media, PA 19063
610.891.0100
Register Online for Camp


CONTRACT INFORMATION SHEET
All sessions of camp require a $200 non-refundable deposit payment. If you are registering prior to March 1, 2010, you will receive a $50 discount on registration. Payment in full is required 30 days prior to camp.

 
 Online Registration for Camp Media Theatre
Session #1 (June 21 - July 2, 2010):
Session #2 (July 5 - July 16, 2010):
Session #3 (July 19 - July 30, 2010):
Session #4 (Aug 2 - Aug 13, 2010):
Session #5 (Aug 16 - Aug 27, 2010):
Parent/Gaurdian Name: *
Address: *
Address 2:
City: *
State: *
Zip: *
Primary Phone: *
Secondary Phone:
Email: *
Camper's Name: *
Camper's Age: *
Date of Birth: *
Emergency Contact: *
Relationship: *
Phone: *
Camper's Physician: *
Address: *
City: *
State: *
Zip: *
Phone: *
Last Tetanus Shot:
Insurance Company:
Allergies:
Medications:
Credit Card Type:
Visa
MasterCard
AMEX
Discover
Credit Card Number: *
Expiration Date: *
Name on Card: *
Pay in Full ($525):
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All Sales Are Final.  No refunds, exchanges only. 
Registrations placed online are subject to a $10.00 handling fee.

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