test form - Indiana Repertory Theatre

IRT Theatre Camp

"*" indicates required fields

Step 1 of 4

Camper Name*

First Last

Name to put on name tag*

Age*

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Grade Entering in the Fall*

School*

Pronouns*

T-Shirt Size*

Parent/Guardian Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mini Camp (Grades K-2)*

Camp 1 (Grades 3-5)*

Camp 2 (Grades 3-5)

Camp 3 (Grades 3-5)

Camp 4 (Grades 3-5)

Camp 1 (Grades 6-8)*

Camp 2 (Grades 6-8)

Camp 3 (Grades 6-8)

Camp 4 (Grades 6-8)

Camp 1 (Grades 9-12)*

Camp 2 (Grades 9-12)

Camp 3 (Grades 9-12)

Camp 4 (Grades 9-12)

For Two-Week Acting Intensive Only:

The next two fields are for those signing up for the Two Week Acting Intensive ONLY. While there is no application for this camp, these fields are an assessment of the camper’s experience and interest in acting. Please note: the Two-Week Intensive is not for beginners. Registrants must show a focused interest in acting and theatre. Please direct any questions to education@irtlive.com.

Please list any and all acting/theatre experience. (Can be classes, productions, school shows, etc.)*

What excites you about acting? Why do you want to join the Two Week Acting Intensive? (100 word limit)*

Is your child taking any medication that we should know about, or that they will be taking during the time with us?

May we administer ibuprofen or non-aspirin Tylenol® if your child requests it? (for headache, etc.)*

Yes

Please list any allergies your child has, including food.

Please identify in detail any IEPs, 504 plans, behavioral or physical access needs, or other information you want us to know.*

Emergency Contact 1 Name*

First Last

Relationship to Student*

Phone*

Email*

Emergency Contact 2 Name

First Last

Relationship to Student

Phone

Emergency Contact 3 Name

First Last

Relationship to Student

Phone

I confirm that my child can support a safe, collaborative, and positive environment for themselves, as well as the other campers, teaching assistants, teaching artists, and IRT staff present at camp. If my child needs additional support to demonstrate the skills below (for example, reading, speaking, or physical supports), or my child can meaningfully contribute to a positive camp environment in a way not listed here, I will share support needs to the IRT staff before the beginning of camp.*

This means that in a supervised environment, they can:

1. Read at (or near) grade level, including reading a script aloud in their group of up to 15 students

2. Follow instructions regarding safety, classroom behavior, and age-appropriate theatre exercises, scene work, and games

3. Treat other campers, staff, and the building with respect through their words and actions

4. Remain in approved areas of the building without wandering off

5. Self-regulate or ask for support when personal challenges or stressors arise

6. Participate in camp activities that stretch their skills and comfort zone, and remain open to trying new things

7. Keep phones and other technology stored during instructional time

I understand if my child is unable to meet these expectations, an IRT staff member may reach out to me to gain insight, context, and inquire how to best support my child while maintaining a positive camp environment. If repeated behavior remains disruptive to the camp environment, my child may be asked to leave camp either for the day, or for the remainder of that week's session.

Following any necessary communication regarding these challenges, significant and/or repeated behavioral issues that are disruptive to the camp environment may mean that my child is asked to leave camp, either for the day or for the remainder of that week’s session.

I confirm that I have shared important details regarding accommodations, access needs, and/or additional background information to set my child, their teaching assistant supervisors, and their teaching artists up for success. I acknowledge that this camp balances artistically challenging classes with the fun of summer camp, and that by providing this information, I am helping my child feel safe, supported, and regulated during a full day of learning and fun.

I Confirm

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IRT Theatre Camp

For Two-Week Acting Intensive Only: