Flatwater Shakespeare Company: Little But Fierce Registration 2018
There is space on this form to register up to TWO students.
IF YOU WOULD LIKE TO REGISTER MORE THAN TWO STUDENTS, please complete a second form.
Email address *
Please note that spaces are limited, and allocated on a first-come, first-served basis. This education activity is for students entering grades K-6th.
LBF 2018
FEE: We want every young person to have an opportunity to explore theatre at little or no cost, so we do not charge a fee. However, if you are able to contribute to this program and would like to help us continue this mission, donations are appreciated and accepted. Checks can be made out to Flatwater Shakespeare Company, PO Box 84935, Lincoln, NE 68501, or you can donate online at www.flatwatershakespearecompany.org.
Which Session are you registering for? *
Three Sessions
Student 1 NAME *
Your answer
Student 1 AGE *
Your answer
Student 1 Date of Birth *
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DD
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Student 1 Grade in fall/School *
Your answer
Student 1 Gender *
Student 1 TShirt Size *
Student 2: NAME
Your answer
Student 2: Age
Your answer
Student 2: Date of Birth
MM
/
DD
/
YYYY
Student 2: Grade in fall/School
Your answer
Student 2: Gender
Student 2: TShirt Size
MAILING ADDRESS *
Your answer
Parent/Guardian NAME *
Your answer
Parent/Guardian PHONE *
Your answer
Parent/Guardian EMAIL *
Your answer
MEDICAL RELEASE:The above named person is in good health. In the event that I cannot be reached for an emergency requiring medical attention, I grant permission to Flatwater Shakespeare Company staff and volunteers to transport my child to a doctor or hospital designated by the staff to attend my child. Please note – Flatwater Shakespeare Company staff/volunteers will not administer any medications.
**You will be asked to sign a medical release on the first day of the session.**
Emergency Contact: Name *
Your answer
Emergency Contact: Phone *
Your answer
Doctor: Name *
Your answer
Doctor: Phone *
Your answer
Medications *
Your answer
Allergies *
Your answer
Other health notes:
Your answer
VIDEO/PHOTO Release---*you will be asked to sign a release on the first day of the session* *
RELEASE OF CHILD: Parents are expected to either pick up their child or arrange for an alternate person to pick them up. Children may be authorized to leave without a parent/guardian. Please indicate your plan for your child after the sessions. *
BEHAVIOR POLICY: Youth theatre provides a place where children can feel comfortable, safe and non-threatened, and can explore and express their personal creativity. Inappropriate behavior and continual discipline problems cause difficulty for staff and other children. FSC’s objective is to deal promptly and fairly with behavior problems. It is our aim to resolve behavior problems in order to avoid the child’s dismissal from the program. Our first step will be to speak with the child to resolve the situation. If the behavior continues, FSC staff will notify the parent/guardian for assistance. Inappropriate behavior that continues will result in dismissal from the program by the FSC Executive Director.
Please share anything else you’d like us to know about your child:
Your answer
I/We have read these policies outlined above. My signature here indicates my acceptance of these policies. TYPE YOUR NAME and the DATE for ELECTRONIC SIGNATURE. *
Your answer
For questions, please contact: Michelle Zinke, Outreach Coordinator, mkzinke@aol.com 402-613-9661
A copy of your responses will be emailed to the address you provided.
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