Registration

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Week 3 Registration

Child Information

First Name *

Last Name *

Age *

Grade *

Name of School *

Information

Payment Method *

I Am Mailing In A Check

I Am Paying By Paypal

I Am Applying For A Scholarship

Optional payment plan is available: $100 non refundable deposit due at registration to hold your spot. Would you like to sign up for the payment plan? *

No Thanks

Yes, Use The Payment Plan

Email *

Home Phone *

Best Parent Contact Number *

Alternate/Emergency Contact Number *

Address

Apt, suite, etc.

Country

City

State

Zip code

Physician Name *

Physician Phone Number *

Any Medical Concerns?

Any Diet Restrictions?

Anything Special We Should Know About Your Child?

Select Film Rating *

Either One Is Okay

All films made during summer camp will be either G rated (see Gopher Dreaming, Lost On Barduino, The McGuffin, Fantasy A’hoy, & Clementine) or PG rated (see Slotter Room, Blood Sisters, The Spaghetti Monster, Retirement, & Zombie Pizza Party).

Because we know that some filmmakers are only interested in one or the other, please indicate:

I want to be a filmmaker behind the scenes! (Examples: directing, camera, boom operator, sound mixer, key grip, gaffer)

I want to be an actor in front of the camera!

I want to work behind the scenes as well as act in front of the camera.

Liability & Media Release forms printed & signed? You can either mail these in to us with your check payment or bring them in to the first day of camp.

If paying by check, please make sure we recieve the payment a week before camp starts or we will need to fill the spot. If you are getting an early bird discount, please make sure we recieve the check before the early bird deadline.

If paying by Paypal, click on the Pay Now button that will appear on the next page after you submit this registration form.

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P.O. Box 67 • Aptos, CA 95001 • (831) 612-6312
ThomasFarmFilms@gmail.com

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