CAMPS_files/2015 Enrollment Form
CAMP ROXY!
AT MUSKOGEE’S HISTORIC ROXY THEATER
ROXY ARTS INTENSIVE
AGES 13-16
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Performance: Friday, July 17 th at 5:30p.m.
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Performance: Friday, July 24 th at 5:30p.m.
____________________________________________________________________________________
CAMP ROXY Performance Camp
AGES 6-12
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Performance: Friday, July 17 th at 5:30p.m.
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Performance: Friday, July 24 th at 5:30p.m.$
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A Product of “Avery Frix’s Summer Performance Camps” | Produced by Oxford Productions
P.O. Box 1039 Muskogee, OK 74402 | 918-608-5903 | OxfordMuskogee.com
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CAMP ROXY!
AT MUSKOGEE’S HISTORIC ROXY THEATER
ENROLL ONLINE: www.Oxfordmuskogee.com
—OR—
ENROLL BY MAIL: Camp Roxy, P.O. Box 1039 Muskogee, OK 74402
ROXY ARTS INTENSIVE
AGES 13-16
Mark the camps you wish to attend.
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Performance: Friday, July 17 th at 5:30p.m.
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Performance: Friday, July 24 th at 5:30p.m.
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CAMP ROXY Performance Camp
AGES 6-12
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Performance: Friday, July 17 th at 5:30p.m.
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Performance: Friday, July 24 th at 5:30p.m.$
Student Information:
Name:_________________________________________________
T-Shirt Size:___________ Age:__________ Date of Birth:_____________________ Gender:________
Please state any conditions, medications and any allergies of which the Roxy staff needs to be made
aware. ______________________________________________________________________________________
_____________________________________________________________________________________________
Parent / Guardian Information:
Name ___________________________________________________________________
Mailing Address_________________________________________________________
Phone (home)______________________ (cell)________________________
A Product of “Avery Frix’s Summer Performance Camps” | Produced by Oxford Productions
P.O. Box 1039 Muskogee, OK 74402 | 918-608-5903 | OxfordMuskogee.com
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CAMP ROXY!
AT MUSKOGEE’S HISTORIC ROXY THEATER
E-Mail Address___________________________________________________
In Case of an Emergency Contact:
1) NAME___________________________PHONE________________________________
2) NAME___________________________PHONE________________________________
Authorization of Emergency Care:
I hereby authorize any physician, surgeon, or dentist on the medical staff of the nearest medical
facility in Oklahoma, to administer any emergency treatment procedure or medicine necessary or
advisable when Oxford Production’s staff accompany my child to the emergency room at the nearest
medical facility. I also authorize Oxford Production’s staff to secure the use of an ambulance, if
necessary for transporting my child to the hospital. I further agree to pay the hospital, doctors, and
ambulance service for all services rendered to the above named patient. I request that this
authorization remain in force as long as my child is enrolled as a participant in Oxford Production’s
CAMP ROXY.
Signature_____________________________________________________________
Photo Release:
I hereby give Oxford Productions the authority to use any photograph/video tape footage of my child
for public relations purposes.
Signature________________________________________________________
Liability Release:
I am the parent/guardian of _________________________________who is participating in Oxford
Production’s CAMP ROXY. It is my understanding that Oxford Productions and all persons acting on
its behalf will do their utmost to assure that my child will be safe at all times. Nonetheless, I
understand that this camp involves a high level of physical activity and Oxford Productions cannot
assume responsibility for any injury which may occur.
Signature________________________________________________________
Cost:
" Early Bird Tuition: $60.00 per week (If Enrolled by June 1, 2015)
" Standard Tuition: $65.00 per week (If Enrolled after June 1, 2015)
o Includes Camp T-Shirt, Daily Snack and All Performance Materials
" A deposit payment of $30.00 is required to reserve your spot in the camp, the remaining
balance will be due the first day of camp.
Payment Options: Please attach one of the following payment forms to the application
! Full or Partial Scholarship (Attach Scholarship Application)
! Check (Payable to Oxford Productions)
! Cash
! Credit Card *Transactions will be charged a processing fee.
Name on Card: ____________________________Visa / Discover / Master Card / AMEX Exp. Date:___/____/___
Card Number: ______ ______ ______ ______ 3-Digit Code on Back __________ Zip Code ____________
Return Forms:
# CAMP ROXY: P.O. Box 1039 Muskogee, OK 74402
A Product of “Avery Frix’s Summer Performance Camps” | Produced by Oxford Productions
P.O. Box 1039 Muskogee, OK 74402 | 918-608-5903 | OxfordMuskogee.com
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