ECCT Spring '19 Class Registration
This entire form must be completed for EACH student you wish to enroll. Both the contact and agreement at the bottom must be accepted in order for your child to participate.
Student Information
Full Student Name *
Your answer
Student's Current Age *
(at time of enrollment.)
Student's Current Grade *
(or grade they are heading into.)
Student T-Shirt Size ($10.00) *
Student Medical
Please provide a list of allergies and medications your child/ward has/is taking. Please use N/A if not.
Allergies: *
Your answer
Medication(s): *
Please note, ECCT personnel WILL NOT dispense medications to your child.
Your answer
Class Choice
Class Choice *
Please choose the class(es) you would like to enroll your Child/Ward in (please mind dates, times and grade restrictions as indicated on website ):
Required
Parent Information
Parent/Guardian *
Your answer
Parent/Guardian City *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Payment & Contact Email *
Payments are primarily collected using PayPal. Whether paying with PayPal (thru a registered email), or Credit/Debit Card, please use the same email address here as during payment.
Your answer
Emergency Contact *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact 2
Your answer
Emergency Contact Relationship 2
Your answer
Emergency Contact Phone Number 2
Your answer
Photography Release
Photography Release *
You have my permission to use photography in which my child/ward appears, for Ellis County Children’s Theater publicity.
Required
Dismissal Information
I authorize ECCT to release my child/ward to the following persons (one required):
Release to Name 1 *
Your answer
Release to Phone 1 *
Your answer
Release to DL# 1 *
Your answer
Release to Name 2
Your answer
Release to Phone 2
Your answer
Release to DL# 2
Your answer
How did you hear about ECCT?
How did you hear about ECCT? *
Check all that apply.
Required
Cast Member Behavior Contract
Cast Member Behavior Contract *
To be reviewed by child/ward WITH parent/guardian. View contract here: https://drive.google.com/open?id=1cmdkaQdrjjLDXjFA0ZZ5J7-5XTJ3cplAZbhWeN-hOu4 - By checking the box in front of "I Agree", I am indicating that the child/ward has reviewed this Cast Member Behavior Contract with the parent/guardian and agree to abide by the rules. I understand that if I fail to follow any of these rules, I could be disciplined and/or sent home from camp at the discretion of the ECCT Director. In the event that I am sent home, no refund will be given. Following these rules will help camp be a safer, happier environment for everyone.
Required
Conduct & Hold Harmless Agreement
Conduct & Hold Harmless Agreement *
To be reviewed by parent/guardian. View agreement here: https://drive.google.com/open?id=1JtYHaVNv6tAbr2a-MrpUDjWVl37iFN8clxGHp0F8Yl8 - By checking the box in front of "I Agree", I am indicating that I (Parent/Guardian), have reviewed the Code of Conduct and Hold Harmless Agreement. I approve of my child/ward's enrollment in the Ellis County Children's Theater program, and will take responsibility in seeing that they comply with the stated code of conduct.
Required
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