Complete this registration form to express interest in Portland Stage. 
Portland Stage will reach out to confirm the registration. Thank you. 
Cargiver Name *
Caregiver Relationship *
Email *
Phone number *
Student 1 - name *
Student 1 - date of birth *
Student 1 - grade level Fall 2021 *
School *
Which Camp are you interested in? *
Does your student(s) have any allergies or other health concerns that our education staff should be aware of? If so, please list them below. *
Anything else you would like for us to know about your student
Street address *
State *
Zip code *
Allow PS to us my childs photo video audio *
Release Part 1 *
Release Part 2 *
Behavior Policy
* = required field