Spring 2020 Audition Workshops
Director of Education: Melanie Lewis
Youth Guild Coordinator: Deborah Hannah

Sam Bass Theatre SBCT: (512) 763-7228
600 N Lee Street
Round Rock, TX 78681
Email address *
Please fill out this entire form. Payment information is at the bottom.
Name: *
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Age: *
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Grade Level 2019-2020 *
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I am registering for *
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Gender *
Date of Birth *
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Parent / Guardian Name *
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Address *
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Parent/ Guardian Phone Number *
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Any known allergies or other pertinent medical information: *
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Emergency Contact (In addition to Parent/Guardian Listed) *
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Emergency Contact Relationship to Student *
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Emergency Contact Phone *
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Primary Doctor Name and Phone Number *
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Preferred Hospital In Case of Emergency *
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Release From Liability
I hereby give permission for My Child Camper Listed Above, to participate in the Sam Bass Theatre Youth Guild Workshop. I declare that I am the parent or legal guardian of the above named child, and I have custody and control of the child. In the event my child is injured or should require medical attention, I hereby request that you contact me or our
emergency contact. In the event that we cannot be reached, I hereby authorize the Sam Bass Theatre to secure necessary medical treatment for my child. I further acknowledge that I will be responsible for any medical or hospital fees or costs associated with my child’s medical treatment. I understand that as a participant, my child may be climbing on and off of stage and set pieces. I further understand that my child may be running, jumping, dancing and varied other movements on stage. I understand that my child may be running, jumping, dancing near moveable set pieces. I assume all risks and hazards to such participation including transportation to and from rehearsals and performances and hereby waive,
release, absolve and indemnify and agree to hold harmless, Sam Bass Theatre, it’s organizers, sponsors, supervisors,
and participants for any claim arising out of accidental injury to my child.

** A PAPER VERSION OF THIS FORM WILL BE REQUIRED TO BE SIGNED AT THE WORKSHOP BEFORE THE PARTICIPANT WILL BE PERMITTED TO ATTEND **
By checking yes I have indicated that I have read, understand, and agree to the terms of the above RELEASE FROM LIABILITY. *
Required
I understand my child's photo or video images may be used by Sam Bass Theatre for the purposes of Marketing and Promotion Including but not limited to newspapers, television, the Sam Bass website, facebook, instagram, and other social media platforms? *
Required
To pay for your workshop(s) online visit this link: https://sambasstheatre.buyplaytix.com/reserve/audition_workshops.html?fbclid=IwAR0Gkr6MNtflD1msqQLyoJVoFsWeVPzmk3Swpcc8HIQKaJQ_vQnHpPoTzRo
Registration and payment must be made before by 4/14/20 and no refunds will be given after 4/14/20. If minimum enrollment is not met, class will be cancelled and refunds will be given.
Paying online will add a small fee.

If you choose to pay by check or cash, please text 817-597-5351 to make arrangements.

I have paid for the workshop via the link above or made arrangements to pay by cash or check, and I understand no refunds will be given after 4/14/20 *
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