Please provide the following information (* required)

Camp Information	(Required)
June 11-15, 9AM-3PM, $199 @CCP	Not registered Registered
June 18-22, 9AM-3PM, $199 @CCP	Not registered Registered
Actor Information	(Required)
*First Name
*Last Name
*Street Address
*City
State	GA
*Zip
*Home Telephone
Cell Telephone (if applicable)
E-mail address (if applicable)
*School
*Grade (2012-2013 School Year)	Select 6th 7th 8th
*High School Graduation Year
*T-shirt size	Select youth small youth medium youth large adult small adult medium adult large adult XL adult XXL
*Best Normal Contact Method	Select Home Telephone Actor Cell Phone Actor E-mail Parent #1 Work Phone Parent#1 Cell Phone Parent #1 E-mail Parent #2 Work Phone Parent #2 Cell Phone Parent #2 E-mail
Emergency Information	(Required)
*Emergency Contact Name
*Emergency Contact Number
Parent #1 Information	(Required)
*Parent First Name
*Parent Last Name
Street (if different than actor)
City
Zip
*E-mail address
*Home Telephone
Cell Telephone (if applicable)
Work Telephone (if applicable)
Parent #2 Information	(Optional)
Parent First Name
Parent Last Name
Street (if different than actor)
City
Zip
E-mail address
Home Telephone
Cell Telephone (if applicable)
Work Telephone (if applicable)
Preferences	(Required)
*Payment Method	Select Major Credit Card (via PayPal) Check (via US Mail) Undecided   After clicking the "Submit Form" button, you will be re-directed to a separate payment page.  Your response to this question helps CCYP understand and plan for your payment preference; your credit card will not be charged at this time.