Our Studio Registration Form
Welcome! We are so happy that you've decided to sign up for one or more of the programs at Our Studio! Please fill out the information below so we can get to know you a little bit better then send it our way. If you have any questions, you can always reach us at info@ourstudiokw.com or call Lori at 519-501-6747 or Cristin at 226-600-9162. We'll see you soon!
Email address *
PARTICIPANT INFORMATION
Participant's First Name *
Your answer
Participant's Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
Language Preference *
Your answer
Address *
Your answer
City *
Your answer
Postal Code *
Your answer
Phone Number *
Your answer
Cell Number
Your answer
Parent/Guardian Name (first & last) *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Cell Number
Your answer
Parent/Guardian Work Number
Your answer
EMERGENCY & HEALTH INFORMATION
Emergency Contact Person (first & last name) *
Your answer
Relationship to the Participant *
Your answer
Phone Number *
Your answer
Doctor's Name *
Your answer
Doctor's Phone Number *
Your answer
Health Card Number *
Your answer
Does the participant have any allergies? If yes, please list. *
Your answer
Are there any medical concerns that we need to be made aware of (eg. asthma, diabetes, dietary restrictions, seizures, etc.)? If yes, please provide details below. *
Your answer
Please list all medications, even if not taking during the program. *
Your answer
If medication is required to be taken during the program, is the participant able to self-administer their medications independently? *
What do people need to know to make this space safe and happy for you? *
Your answer
T-SHIRT AND COSTUME INFORMATION
What is your t-shirt size? *
What is your pant size? *
Your answer
What is your dress size? *
Your answer
What is your shoe size? *
Your answer
PROGRAM INFORMATION & FEES
Invoices for our program will be emailed at the start of each month. You have the option to pay online, directly from the invoice or you can choose one of the following options below.
Which program/s would you like to register for? *
Required
How would you like to pay? *
If choosing to pay with SSAH or Passport Funding, I give permission for Our Studio to invoice Extend-A-Family Waterloo Region on my child's behalf to cover the registration fee. Please type your name below.
Your answer
Photo Release - I consent to have my photo (or my child's photo) taken during the program, including headshots and photos taken during performances, and used for promotional purposes. I understand that photos may be used on social media, online and in print format. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy