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SHOWTIME Registration Form
Student Name (first, last)
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Student Address
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City
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State
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Zip Code
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Best Phone Number (*If both parents Phone Numbers need to receive information write "both")
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Best e-mail (*If both parents emails need to receive information write "both")
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Mother's Name (first, last)
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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 (first, last)
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Father's Address
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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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Student's Gender
Shoe Size
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T-Shirt Size
School Attending
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Grade
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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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Family Physician Name
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Family Physician Phone Number
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Allergies or medical information we should know about this student
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*Please select all Classes student is enrolling in
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Registration Fee (Returning student discounted fee applies for students attending SHOWTIME in the past 12 months)
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 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 no refunds will be given for tuition and fees. I agree to the waiver above by typing my full name (first, last) below.
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Today's date.
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How did you hear about us?
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Questions/Comments?
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