Play it Up Club Registration
Fall 2019 Session
Child's Information
Child's Name *
Your answer
Current Age *
T-shirt Size *
Allergies/Special Needs
Your answer
Parent/Guardian and Contact Information
Parent/Guardian Name *
Your answer
Streeet Address *
Your answer
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number (where you can be reached) *
Your answer
Please let us know if you're able to help provide refreshments on one or more nights!
Consent for Participation and Medical Release
I give permission for my child to "Play it Up" for the next 13 Wednesdays beginning Sept. 11, 2019. The children in Play it UP will perform an opening act during the pre-show for the 2nd-6th grade musical, "The Secret of Snowflake County," which will be performed on Saturday, December 7th and Sunday, December 8th, at 6:00 PM. *
I give permission for my child to be photographed and/or recorded on video. *
I give my permission for the SHCN Play it Up Club staff to administer basic first aid to my child in the event of an injury. I understand that staff will contact emergency services (911) in the event of a significant injury and all expenses for such emergency services will be paid by me. *
Registration Fees
If paid before September 11th: $20
After September 11th: $25

Please make all checks payable to: SHCN (Play it Up in memo)

If you have any questions, please contact Ms. Cathy:
Phone Number: (412) 841-7440
Email Address:
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