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Parent/ Caregiver Information

Emergency Information

Medical Information

Authorization for Emergency Care to a Minor

As the Parent/Guardian of the aforementioned child, I authorize such diagnostic, medical, and/or surgical treatment of my child as may be considered necessary or appropriate under the circumstances for the treatment of any illness or injury, by licensed emergency medical professionals. *

Photo Release Statement

I give permission and consent for photographs to be taken of my child during camp session activities. I further give permission and consent that any such photographs may be published and used by Yellow Brick Theater to illustrate and promote the camp experience and its programs. I release Yellow Brick Theater from all claims, demands, and liabilities whatsoever in connection with the above. *

Camp T-Shirt Order

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Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. *
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Youth Summer Camp tuition is $435. Payment plans are available.

A DISCOUNT is available for siblings. Deduct $25 off the price of tuition for the second child enrolled. For a third and/or fourth child, deduct $50 off of each child's tuition.

REFUND POLICY: A full refund for Youth Camp tuition is available if YBT is notified before May 15th. After May 15th, a 50% refund will be given. All refunds will include a 3.5% deduction to cover PayPal fees.

Check/cash payments may be sent to: Yellow Brick Theater c/o Dionne Meyer 3746 Mesquite Dr. Beavercreek, OH 45440. Checks may be made payable to Yellow Brick Theater. A $25 fee will be charged for returned checks.

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