2019 Winter/Spring Class Registration Form
CAST children's theatre
PO Box 1268
113 Summit Street
Manchester, CT 06045-1268
(860) 649-5062
info@casttheatre.org

If you have any problems with this form or have any questions, contact CAST.
**PLEASE MAKE SURE YOU ARE SCROLLING DOWN TO THE BOTTOM OF THIS FORM AND HITTING SUBMIT. REGISTRATION FEE INFORMATION CAN BE FOUND AT THE BOTTOM OF THIS FORM and will also be in the confirmation e-mail you will receive once you hit the submit button.

****If you are paying with a credit card, please make sure after you fill this form out you follow the link to pay with paypal located on this form****

****If you check off that you are sending in a check to our office - checks must arrive within 4 business days before your registration is voided.**** There is a $15.00 fee for returned checks.

****Please check your calendars for any conflicts with performances dates before registering (i.e. competitions, sports, recitals, etc.)****

2019 Winter/Spring class options are:

"Disney's Winnie the Pooh KIDS" for ages 5-12 on either Wednesdays or Saturdays.
$250.00 for the entire session

Wednesday class begins January 2, 2019 from 4:30 pm - 5:30 pm with shows April 26-28, 2019

Saturday class begins January 5, 2019 from 9:00 am - 10:00 am with shows May 3-5, 2019

**Tickets to productions are extra**

"A Year With Frog and Toad KIDS" for ages 8-14 on Tuesdays
$250.00 for the entire session

Tuesday class begins January 8, 2019 from 5:00 pm - 6:00 pm with shows April 5-7, 2019

**Tickets to productions are extra**

"Once On This Island, Jr." for ages 8-18 on either Mondays or Saturdays.
$285.00 for the entire session

Saturday class begins January 12, 2019 from 10:30 am - 12:00 noon with shows May 10-12, 2019 (Mother's Day Weekend).

Monday class begins January 7, 2019 from 4:30 pm - 6:00 pm with shows May 17-19, 2019.

**Tickets to productions are extra**

**Please see the details and dates of all classes on the CAST website - www.casttheatre.org** Please make sure you check dates for any conflicts prior to registering.


PayPal Options:

$50.00 non-refundable registration fee for either "Disney Winnie the Pooh KIDS", "A Year With Frog and Toad KIDS" OR "Once On This Island, Jr." Use this link: https://tinyurl.com/castregfee

"Winnie the Pooh KIDS" or "A Year With Frog and Toad KIDS" - Full registration fee of $250.00 (includes non-refundable registration fee) - use this link: https://tinyurl.com/castfullkidsfee

"Once On This Island, Jr." - Full registration fee of $285.00 (includes non-refundable registration fee) - use this link: https://tinyurl.com/castjrfull

****IT IS VERY IMPORTANT THAT YOU FILL OUT THIS FORM FIRST AND HIT THE SUBMIT BUTTON BEFORE CLICKING ON A PAYPAL LINK **** LINKS TO PAYPAL SHOULD APPEAR ON THE CONFIRMATION WINDOW AND IN THE CONFIRMATION E-MAIL YOU WILL RECEIVE ONCE YOU HIT SUBMIT. IF YOU DO NOT SEE THEM, PLEASE COME BACK TO THIS FORM FOR THE PAYMENT LINKS.

PLEASE DO NOT SUBMIT MORE THAN ONE REGISTRATION FORM PER STUDENT.

If you have any problems with this form, please contact the CAST office.

Thank you.

CAST children's theatre * info@casttheatre.org * 860.649.5062

Email address *
Student Date of Birth: *
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Student First Name: *
Your answer
Student Last Name: *
Your answer
Gender: *
Age: *
Your answer
Grade: *
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Home Address: *
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City/Town: *
Your answer
State: *
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Zip Code: *
Your answer
Student Cell (if any):
Your answer
Student E-mail (if any):
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Home Phone # (if any):
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Parent 1 Name: *
Your answer
Parent 1 Cell #: *
Your answer
Parent 1 E-mail Address: *
Your answer
Parent 2 Name:
Your answer
Parent 2 Cell #:
Your answer
Parent 2 E-mail Address:
Your answer
Guardian Name (if applicable):
Your answer
Guardian Cell (if applicable):
Your answer
Guardian E-mail Address (if applicable):
Your answer
Student lives with: *
Required
Does your child have: *
Yes
No
Special Physical Needs?
Allergies?
Behavioral Problems?
Medical Needs?
Current Medication?
Please list any medical concerns of which staff should be aware: (allergies, medical conditions, current medications, or physical limitations):
Your answer
Are any of the following true: *
Yes
No
There is a cristical situation / important transition happening at home.
My child has been hospitalized within the last 3 years.
My child has been diagnosed with Attention Deficit / Hyperactivity Disorder (AD/HD).
My child has been diagnosed with Obsessive / Compulsive Disorder (OCD).
My child has been diagnosed with a learning or procession disorder.
If yes to any of the above, please explain here:
Your answer
Doctor's Name:
Your answer
Doctor's Phone #:
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Dentist's Name:
Your answer
Dentist's Phone #:
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Insurance Company or Medical Plan:
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Insurance Plan Number (if applicable):
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In case of Emergency:
In the event of an emergency, if a parent or guardian can not be reached first, please list the name of a contact other than the one listed above. EVERY effort is made to reach a parent or guardian first.
Name: *
Your answer
Relationship: *
Your answer
Home Phone #: (if applicable)
Your answer
Cell Phone #: (if applicable)
Your answer
I give my child, who is named at the top, permission to participate in the class(es)/productions for which he or she is registered. My child may be photographed and/or videotaped during the course of the program. I understand that CAST may use such images for archival or promotional purposes. In the event of an emergency during which I cannot be reached, I give permission to the bearer of this form to allow any doctor or medical facility to administer appropriate emergency procedures as may be necessary in the best interests of my child.
Parent Initials: *
Your answer
Parent Signature (type name here): *
Your answer
Date: *
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How did you hear about CAST?
I would like to register for: *
Required
Payment Options:
A non-refundable $50.00 registration fee reserves a space in each class. This fee will be applied to your final balance. We must receive this registration deposit or full registration fee in order to hold your space. If you are signing up for more than one class or signing up more than one child, please pay the $50.00 fee per student/class and we will send you an invoice with the correct balance (that includes any multi-class or family discount).
We will: *
Please send us information on Scholarship Assistance:
I am interested in setting up a payment plan. Please have someone contact me:
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