Camp Broadway Registration Form

June 7-11, 2021
FSCJ Artist Series  
Nathan H. Wilson Center for the Arts  
11901 Beach Blvd. Jacksonville, FL 32246 

PLEASE NOTE: Payment is required to hold your spot and to complete this application. Click here to make a payment and then return to complete and submit this application.

Camper Information

What shirt size?*

Parent/Guardian Information

Please list one parent/guardian in this section as the primary contact for your camper. Additional contacts can be added in the next section if desired. 

Each camper will receive four complimentary tickets to the Family Finale on the final day of camp. Tickets will be mailed approximately 2-4 weeks prior to camp.

Additional Contact Information

Optional

Authorized Sign Out

In order to ensure the safety of all of our campers, we will not release a child to anyone unless authorized to do so in writing. 

The following person(s) has permission to pick up my child. (Don't forget to include yourself in this list if you will be picking up your camper.)

My child has permission to leave Camp Broadway on his/her own.*

If you select "No," you must come inside the Nathan H. Wilson Center for the Arts at the end of each day to sign your child out. Your child will not be able to meet you in the parking lot unless permission is granted to leave on his/her own.

I am aware and agree that once my child leaves at the end of each session day that neither Camp Broadway nor FSCJ Artist Series are responsible for his/her whereabouts, actions or welfare.*

Medical Information

Insurance Verification*

By checking the 'yes' box, I certify that I have medical insurance covering my child. Also that the information in this release is correct as far as I know. My child has permission to take part in all Camp Broadway activities. I understand that every attempt will be made to contact me in case of an emergency. In the event that I cannot be reached, I give consent to emergency transportation, x-rays, medical treatment(s), surgery or dental care for my child. I agree to assume responsibility for charges so incurred.

Please list any physical injuries or chronic health problems that we should be aware of, e.i. asthma, epilepsy, knee injury, etc.

Please list any medications your child is taking or any other information that we should be aware of.

I give Camp Broadway permission to administer any medications that my child needs assistance in taking. I will provide a copy of the physician's prescription and enough medication in its prescription bottle for the entire week of camp.*

Do you give Camp Broadway permission to administer Tylenol or Advil to your child in the event that he or she is not feeling well? Check all that apply.*

Please include date of late examination, date of DPT/TB, Polio, MMR immunization and date of last tentanus shot

Photo and Liability release

I grant Camp Broadway and FSCJ Artist Series permission to take photographs, and/or make video or audio recordings of my child, and use them in connection with the promotion or publicity of Camp Broadway. I hereby release Camp Broadway and FSCJ Artist Series and their respective employees, independent contractors, directors and/or officers from any legal or financial claims. *

I agree that neither Camp Broadway nor Florida State College at Jacksonville, Foundation Inc. dba FSCJ Artist Series, not any of its employees, independent contractors, directors and/or officers will be held liable for any injury which may occur to my child while attending Camp Broadway. This includes, but is not limited to, any activities in which he/she may participate including classes in signing, acting, dancing, physical comedy, stage craft, theatrical mask work, warm-up exercises and/or me*

Payment

For this next section, you will need the account name and order number from the order confirmation sent via email after payment was made. Payment must be made online. If you have not made payment yet, you can do so by clicking HERE. Spots for camp are reserved when payment is received. 

Please enter the account name in which you have paid tuition under

Please enter the order number provided via email upon paying tuition.

Refund Policy *

If you need to cancel after being accepted into Camp Broadway, your payment is refundable minus a $50.00 handling fee up to 30 days prior to the program's start date. For cancellations within a 30 day period, all payments are non-refundable.