Katergadzomai | Northwestern College in Iowa

Personal information

First name

Last name

Preferred name

Sex

Male

Female

Address

City

State

ZIP code

Phone

Cell phone

Email

Education

High school graduation year

High school you currently attend

Registration information

List the name of the person you plan to room withIf you’re not sure who you’ll room with, you can leave this blank.

Are you a returning camper?

Yes

No

Do you plan to stay in the dorms or off campus?Staying off-campus comes with a $25 discount

In the dorms

Off-campus

Briefly describe any theatre experiences you’ve had.

Do you have any medical concerns we should know about?

Do you have any allergies and/or dietary restrictions?If so, please list.

Parent information

Parent name(s)

Parent phone

Second parent phone

Parent email

Emergency contact

(other than parents)

Name

Phone

Relationship to the student

Medical insurance

Policy number

Provider

Policy holder’s name

Card details

First name

Last name

Address

City

State

ZIP code

Card number

Expiration date

Security codeFor Visa, Mastercard, and Discover, the 3 digits on the back of your card.

For American Express, the 4 digits on the front of your card.

Total amount

$375

Theatre Camp

June 28-July 2, 2026