Request edit access
SHOWTIME Registration Form
Student Name (first, last) *
Your answer
Student Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Best Phone Number (*If both parents Phone Numbers need to receive information write "both") *
Your answer
Best e-mail (*If both parents emails need to receive information write "both") *
Your answer
Mother's Name (first, last) *
Your answer
Mother's Cell Phone Number *
Your answer
Mother's Address *
Your answer
Mother's e-mail *
Your answer
Father's Name (first, last) *
Your answer
Father's Address *
Your answer
Father's Cell Phone Number *
Your answer
Father's Address *
Your answer
Father's e-mail *
Your answer
Student's Age *
Your answer
Student's Date of Birth (mm/dd/yy) *
Your answer
Student's Gender *
Shoe Size
Your answer
T-Shirt Size *
School Attending *
Your answer
Grade *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Address *
Your answer
Emergency Contact Relation to Student *
Your answer
Family Physician Name *
Your answer
Family Physician Phone Number *
Your answer
Allergies or medical information we should know about this student *
Your answer
*Please select all Classes student is enrolling in *
Required
Registration Fee (Returning student discounted fee applies for students attending SHOWTIME in the past 12 months) *
Name as it appears on Credit Card *
Your answer
Credit Card Type *
Credit Card Number *
Your answer
Expiration date (mm/yy) *
Your answer
3 digit code on back of card OR 4 digit code on the front of American Express Card *
Your answer
Billing Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
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, where applicable, there is a maximum of 20% discount per child. No refunds will be given for tuition and fees *
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, where applicable, there is a maximum of 20% discount per child. No refunds will be given for tuition and fees. I agree to the waiver above by typing my full name (first, last) below. *
Your answer
Today's date. *
MM
/
DD
/
YYYY
How did you hear about us? *
Your answer
Questions/Comments?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms