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Summer Classes Registration 2017
Please select all summer classes student is enrolling in ($10 per class). Special $10 class rate applies to GROUP CLASSES ONLY.
Student Name (first, last) *
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Student's Address *
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City *
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Zip *
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Best Phone Number *
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Mother's Name *
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Mother's Cell Phone Number *
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Mother's Address *
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Mother's e-mail *
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Father's Name *
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Father's Cell Phone Number *
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Father's Address *
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Father's e-mail *
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Student's Age *
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Student's Date of Birth (mm/dd/yy) *
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Gender *
Student's Shoe Size *
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T-Shirt Size *
School Attending *
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Grade *
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Family Physician *
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Family Physician's Phone Number *
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Allergies or other medical information we should know about this student
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Emergency Contact Address *
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Emergency Contact Relation to Student *
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Improv - Monday's, Wednesdays and Fridays 3-4pm (Select all dates that your child will attend) *
Required
Musical Theatre - Mondays, Wednesdays and Fridays 4-5pm (Select all dates that your child will attend) *
Required
Acro - Tuesdays &Thursdays 3-4pm (Select all date that your child will attend) *
Required
Tricks, Leaps & Turns - Tuesdays & Thursday 4-5pm (Select all dates that your child will attend) *
Required
Private Lessons - CALL FOR APPOINTMENT
Name as it appears on Credit Card *
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Credit Card Type *
Credit Card Number *
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Expiration Date (mm/yy) *
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3 digit code on back of card OR 4 digit code on the front of American Express Card *
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Billing Address *
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City *
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State *
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Zip Code *
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By checking the box below I authorize SHOWTIME Performing Arts Theatre to charge my tuition, along with any applicable fees which may include: extended care, lunch, class, and/or registration fees to the above listed card. I understand that no refunds will be given for tuition. *
By signing this waiver, I release SHOWTIME Dance and Performing arts Theatre and all of its staff from all claims related to any injury which may be sustained by myself or my child while attending any of our classes, camps or events associated with SHOWTIME Dance and Performing Arts Theatre. I also affirm that I currently have and will continue to carry proper medical, health, hospitalization, and accident insurance, which I consider adequate. Photo release: I understand that as a student, my child may from time to time be included in photos and video-taping of student productions. By signing below, I grant permission for SHOWTIME to use these photos in brochures or promotional material. I understand that no refunds will be given for camp tuition. I agree to the waiver above by typing my name below as well as the date and time (example: Your name first and last, mm/dd/yy) *
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Thank you for submitting your form! You will receive an email confirmation and receipt within 24 hours of your submission.
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