Academy of Theatre Arts 2022 Break & Summer Registration Form
*Please make sure email address is up to date and checked frequently. We use a completely electronic system.
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Email *
Student Last Name *
Student First Name *
Age & Birth Date *
Address *
Parent/Guardian #1 Name *
Parent/Guardian #2 Name (If Applicable)
Phone Number *
Emergency Contact Name & Phone # (Must be different from Parent/Guardian) *
Camp Selection (Please check which camp session you would like to participate in for the 2021 Season) *
T-Shirt Size
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PARENTAL CONSENT:I agree by checking to follow all policies and procedures set forth by Academy of Theatre Arts. I accept the responsibility of reading and following all information communicated by the Academy. I further accept all responsibility of any potential risk associated with participating in a theatre class, and affirm that I have and will provide proper health insurance for my child’s protection. I give permission for emergency medical treatment of my child if a parent cannot be contacted. I hereby grant permission for my child to be photographed by Academy of Theatre Arts for publicity and/or production purposes.
$50.00 Non-Refundable Deposit: (This deposit goes to items that are purchased before the start of camp and cannot be refunded for any reason) *
I would like my final deposit to be... (Please note: Break Camp Final Payment is due ONE WEEK prior to the camp start date) *
If paying by Credit Card (Call in card or leave information below)
Credit Card Number
Expiration Date
How did you hear about our program?
Any Allergies or anything else we should be aware of? (Please include grouping requests here)
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