Theatre Alive! 2019 Registration
Please complete this form to register for the Theatre Alive! Summer Workshop. Bring the $25.00 Registration fee on the first day of the workshop. Please complete a separate form for each student.
Student Name *
Your answer
Parent/Guardian Name *
Your answer
Preferred Guardian Phone Number *
Your answer
Mailing Address *
Your answer
E-Mail Address
Your answer
Special Needs of Student (Medical/Medication/Allergies/Other) *
Your answer
Student's Gender
Student's Age *
Student's Grade Just Completed
Student T-Shirt Size *
Describe any previous performance experience. (Experience not required)
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Name of persons other than Parent/Guardian and Emergency Contact authorized to pick up child *
Your answer
Do you know you will have to miss a day of the workshop due to pre-planned vacation or VBS?
PHOTO AND PUBLICITY WAIVER *
RELEASE OF LIABILITY I hereby release Newport Theatre Guild Board and the hosting location, officers, employees, agents, and any other people officially connected with this event, from any and all liability for damage to or loss of personal property, sickness or injury from whatever source which might occur while participating in this event. I am aware of the risks of participation, which include, but are not limited to, injury due to physical activity. I understand that participation in this program is strictly voluntary and I freely chose to have my child participate. I consent to any medical treatment necessary for my student in an emergency. I understand that the theatre does not provide medical coverage for my child. I verify that I will be responsible for any medical costs that incur as a result of my child’s participation. *
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