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Stratford Trip Option B - Student Registration
Please note: You are not registered until both payment is received, and this form is submitted.
Name of student:
Is the student under the age of nineteen?
If yes, the name of the student's legal guardian completing this form:
If the student is being accompanied on the tour by someone other than their legal guardian, please provide their name.
Emergency Contact Name:
Emergency Contact Number:
Does the student have any medical conditions or allergies that we should be aware of? If so, please list clearly.
Name of Roommate(s):
For the Thursday matinee would you prefer to see:
Wendy & Peter Pan
Much Ado About Nothing
"It doesn't matter to me"
I HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge HEIDI STEPANEK and THE ACADEMY FOR MUSICAL THEATRE and its teachers, employees, and volunteers of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to my participation in any of the functions or activities conducted through the field trip to Stratford, ON, from June 10 to 12, 2020. I have no illnesses, allergies or disabilities that may require special attention, except as described in the registration form above. I authorize Heidi Stepanek and other agents of The Academy for Musical Theatre to disclose these conditions to a physician or other medical professional in the event I should require emergency medical care. I am aware of the usual risks and dangers inherent in participation in all of the activities associated with this trip, and of the possibility of personal injury, death, property damage or loss resulting from the activities. I understand that I must behave in an appropriate and safe manner throughout the duration of the trip. I will be responsible for any costs caused by my failure to abide by an appropriate code of conduct, including any loss or damage of property, or costs to send me home. Accidents can be the result of the nature of the activity and can occur with or without any fault on either the part of the participant, or The Academy for Musical Theatre or its employees or agents, or the facility where the activity is taking place. By participating in this trip, I am accepting the risk of an accident occurring, and agree that this field trip is suitable for me.
I am in satisfactory physical and mental condition to safely participate in the activities listed in the trip itinerary.I am 19 years of age or more and have read and understand the terms of this consent and waiver, and understand that it is binding upon me, my heirs, executors and administrators.
I understand that there are no refunds available, and that if I am unable to attend for some reason my trip may be transferred to another person at my discretion.
Do you agree to the above waiver?
I am nineteen years of age or over and I agree to the waiver.
I am the legal guardian of the above-mentioned student and I agree to the waiver.
I understand that once I am registered costs are incurred by The Academy and thus my purchase cannot be refunded. If I am not able to attend the trip for any reason, I understand that I am able to transfer my trip to someone else at my discretion.
1. First, follow this link make your payment. Note that you can use your credit card (you don't need a PayPal account):
2. Then, return to this page and click the "SUBMIT" button at the bottom of this form.
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