Ballet Bootcamp
Email address *
Student last name *
Your answer
Student last name *
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Primary Phone number *
Your answer
Student Age *
Your answer
Allergies *
Your answer
Emergency Contact *
Your answer
Emergency Contact phone number *
Your answer
I hereby authorize the Staff and Directors representing Walltown Children's Theatre to give consent for any and all necessary emergency medical and First Aid for my child (listed above) while said child is in said individual's custody. *
Click YES to accept
I understand my obligation to pay all fees regardless of my child's attendance and I'm aware that all fees are non-refundable *
How did you hear about Walltown Children's Theatre? *
Number of classes and fees *
Required
Monday class options (check all that apply) *
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Tuesday class options (check all that apply) *
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Wednesday class options (check all that apply) *
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Thursday class options (check all that apply) *
Required
Liability Release
I hereby certify that my child is in normal health and capable of participating safely at Walltown Children’s Theatre (henceforth WCT). I will notify WCT if the participant has any health problems. I am aware that dance training and the associated athletic exercises therein may place unusual stress on the body and carry with it the risk of physical injury. On behalf of my child and myself, I assume all risks and hazards incidental to the conduct of the program. Click YES to accept. *
Publicity Release
I hereby authorize the WCT to record the student’s picture an voice on photographs, films and tapes, to edit these recordings at its discretion, and to incorporate these recordings into movie and films on tapes, DVDs, radio or television broadcast programs. I also give my permission for WCT to use and license others to use these materials in any manner or media whatsoever. WCT is also permitted to use these materials for publicity and advertising. And to use the student’s name, likeness, etc. I acknowledge that no promises of compensation are made by WCT. Click YES to accept. *
Publicity Release
I hereby authorize the WCT to record the student’s picture an voice on photographs, films and tapes, to edit these recordings at its discretion, and to incorporate these recordings into movie and films on tapes, DVDs, radio or television broadcast programs. I also give my permission for WCT to use and license others to use these materials in any manner or media whatsoever. WCT is also permitted to use these materials for publicity and advertising. And to use the student’s name, likeness, etc. I acknowledge that no promises of compensation are made by WCT. Click YES to accept. *
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