Registration
*Please note, one registration form should be submitted per student
How did you pay your down payment? *
Required
For which Program are you registering? *
First Name *
Your answer
Last Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Age as of February 23rd *
Your answer
Gender *
What size t-shirt?
Address: *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
School Name *
Your answer
Grade in Fall 2018 *
Required
How did you hear about Stage Company? *
Required
Parent/Guardian 1 Name *
Your answer
Relationship *
Your answer
Is your address different than the participant? *
Parent Email *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Parent/Guardian 2 Name
Your answer
Is your address different than participant?
Parent/ Guardian 2 Email
Your answer
Cell Phone
Your answer
Emergency Contact's Name *
Your answer
Emergency Phone Contact *
Your answer
Emergency Contact Relationship *
Your answer
Allergies/Medical Information *
Required
Describe Allergies
Your answer
Does your child carry an inhaler? *
Does your child carry an EpiPen? *
Describe any Medical Conditions of which we should be aware. *
Your answer
Tell us about your student? (Does your student have any sensitivities or learning needs of which we should be aware?) *
Your answer
We, (I) as parent(s) or legal guardian(s) give permission for (Student’s Name)_________________________________________ __________________________________ to participate in the Stage Company Theatre Arts Llc. Program which includes all related programs or events. In consideration for our (my) son’s/daughter’s participation in the program, and intending to be legally bound, we (I) and our (my) son/daughter agree and understand that we assume risk in full for our (my) son’s/daughter’s participation in the Program, and with full knowledge of the risk inherent in such an activity, we release and hold harmless the school, Stage Company Theatre Arts Llc., Parish, the Archdiocese of Philadelphia, and its priests, religious, teachers, aides, employees, agents, administrators, and any official representatives, from any and all liability, damages, or claims for any and all personal injury, bodily injury, and/or property damage arising or related to our (my) son’s/daughter’s participation in the Program. We (I) and our (my) son/daughter understand and agree to abide by all rules and regulations established by the school outlined in the Policies (found on website). *
Please add Guardian Parent name & Student's name
Your answer
I understand the the Drama Director casts the roles keeping in mind the entire cast and show. *
I understand that attendance is important this session. I know that if my child misses an a rehearsal, the teaching staff may use an understudy for the scenes/dances missed. *
I give my permission for my child's picture to be used by Stage Company Theatre Arts Llc. on promotional material as well as the website/social media. *
I would like to make full payment by: *
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