JUNIOR Registration Summer 2019
JUNIOR PLAYERS: Grades 3 through 8 (as of 9/2019). Program begins June 24th – ends July 20th
Meets 9 am to 1 pm, Monday through Friday
Performances on Thursday, July 18th at 7 PM and Saturday, July 20th at 2 PM
Child's First Name *
Your answer
Child's Last Name *
Your answer
Address *
Your answer
City/Town *
Your answer
Age *
Your answer
Date of Birth Format: xx/xx/20xx *
Your answer
Enter your grade as of September 2019
Grade *
Home Phone *
Your answer
Mother's/Guardian's Name *
Your answer
Mother's/Guardian's Phone *
Your answer
Mother's Email *
Your answer
Father's/Guardian's Name *
Your answer
Father's/Guardian's Phone *
Your answer
Father's Email *
Your answer
Emergency Contact Name (other than parent/guardian) *
Your answer
Emergency Relationship *
Your answer
Emergency Phone *
Your answer
MEDICAL RELEASE: I authorize all representatives of Newbury Musical Theatre Company to act in my behalf for the purpose of obtaining emergency medical treatment for the registrant.
*
In case of an emergency, which hospital do you prefer? *
CONSENT FORM AND LIABILITY WAIVER: I/We, the parents/guardian give our permission for our child to participate in the Newbury Musical Theatre Company (“NMTC”) program and performances, events and/or productions (“production”). I/We also give our permission for NMTC to use the likeness of our child in photographs, advertisements and Social Media related to NMTC or NMTC productions. Names will not accompany any likeness or image. I agree that my child will abide by all rules and regulations reasonably adopted in connection with NMTC, any production and the use of the facilities provided for NMTC programs or productions. I understand that the failure of my child to observe these rules and regulations may result in my child being excluded from the program or from participation in any production. I agree to waive any and all claims of any kind whatsoever, whether resulting from an injury or otherwise, and further agree to release, indemnify and hold the NMTC, its employees, contractors, volunteers, officers, directors, and representatives harmless from and against any and all liability arising out of or relating to my child’s participation in NMTC programs or any production. I further understand that NMTC assumes no liability for lost, misplaced stolen and/or damaged property and I hereby agree to release NMTC from such liability.
REGISTRATION FEES are due in full by June 17th, 2019. Space is limited. You will be considered registered when we receive registration fee in full. Fees are non-refundable after the program begins. Please make checks payable to: "Newbury Musical Theatre" or call to pay by credit card.
In checking the box and entering your name below, you agree to all the above information. *
Required
Parent/Guardian name *
Your answer
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