The Philadelphia Shakespeare Theatre Presents: Camp Shakespeare
Contact Information
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Camper Name:
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Camper's Age:
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Camper Email:
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Grade Level in Fall '13:
School Attending:
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Guardian/Emergency Contact Name:
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Email:
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Phone Number:
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Phone Number (xxx-xxx-xxxx):
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Mailing Address Line 1:
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Mailing Address Line 2:
Payment Information
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Name on the Card:
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Credit Card Number
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Billing Address Line 1:
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Expiration Date:
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Billing Address Line 2:
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Security Code:
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Amount Paid:
Early Registration Lunch Included: Deposit only ($325)
Early Registration Without Lunch: Deposit only ($312.50)
Early Registration Lunch Included: Full Payment ($650)
Early Registration Without Lunch: Full Payment ($625)
Camp Information
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Shirt Size:
Adult Small
Youth Small
Adult Medium
Youth Medium
Adult Large
Youth Large
Adult X-Large
Youth X-Large
Adult XXL
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How did you hear about us?
Once this form is submitted The Philadelphia Shakespeare Theatre will charge your card on or before March 2, 2013.
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