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Katia & Company

Non-profit theatre company

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Wicked summer camp

Participant name*

Preferred name and pronouns, if different

Grade in fall 2025*

Parent Info

Parent name*

Parent email*

Phone number 1*

Phone number 2*

Emergency phone number to contact in the event that parents cannot be reached*

Choose a location*

Novato, June 30-July 3 0

Larkspur, July 7th WAITLIST0

Novato, July 28- Aug 1 WAITLIST0

I have read and agree to the terms of the waiver.

*

Does your child have any allergies, medical conditions, or developmental concerns we should know about?

If your child has a birthday during camp, please let us know!

Katia & Company

503 South Palm Drive Novato, CA

tax ID 82-222-7982

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