GVT After-School Registration Form
The deadline for Fall Applications is Friday, September 13, 2019 at 5 p.m. For questions or concerns, please contact Education Manager Kiersten White at kiersten@gvtheatre.org or 304-645-3838 ext. 111.
Student Information
Name of Student *
Your answer
Preferred Name *
Your answer
Age of Student *
Your answer
Grade of Student *
Birth Date *
MM
/
DD
/
YYYY
Mailing Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
We ask that you provide a student email if your child is in 6th grade or above so they can also receive communication about classes and anything they might need to bring or rehearse. We will always email parents, as well.
Student's Email
Your answer
Student's School *
If you chose "Other" for your school, please list the school below.
Your answer
Please choose the appropriate after-school class for your child based on their grade. If you are planning on auditioning for Conservatory, please choose that class and email kiersten@gvtheatre.org to select an audition slot. *
Student #2 Information
If you are registering more than one child for after-school classes, please fill out this section. If you are only registering one child, please skip to the next section (Guardian/Parent Contact Information). You can only register two (2) children using this form. If you would like to register more, please contact the Education Office at 304-645-3838.
Name of Student
Your answer
Preferred Name
Your answer
Age of Student
Your answer
Grade of Student
Birth Date
MM
/
DD
/
YYYY
Mailing Address
Your answer
City
Your answer
State
Zip Code
Your answer
We ask that you provide a student email if your child is in 6th grade or above so they can also receive communication about classes and anything they might need to bring or rehearse. We will always email parents, as well.
Student's Email
Your answer
Student's School
If you chose "Other" for your school, please list the school below
Your answer
Please choose the appropriate after-school class for your child based on their grade. If you are planning on auditioning for Conservatory, please choose that class and email kiersten@gvtheatre.org to select an audition slot.
Parent/Guardian Contact Information
Please note that our primary form of communication will be through email. If this is an issue or you have limited internet access, please let us know by calling 304-645-3838 ext. 111.
Name of Parent/Guardian #1 *
Your answer
Parent/Guardian #1 Email *
Your answer
Parent/Guardian #1 Cell Phone Number *
Your answer
Parent/Guardian #1 Home Phone Number
Your answer
Parent/Guardian #1 Work Number
Your answer
Name of Parent/Guardian #2
Your answer
Parent/Guardian #2 Cell Phone Number
Your answer
Parent/Guardian #1 Home Phone Number
Your answer
Parent/Guardian #2 Work Number
Your answer
Parent/Guardian #2 Email
Your answer
Emergency Contact Information
Please list at least one Emergency Contact for your child or children that is not a parent.
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #1 Relationship to Student *
Your answer
Emergency Contact #2 Name
Your answer
Emergency Contact #2 Phone Number
Your answer
Emergency Contact #2 Relationship to Student
Your answer
Please list any allergies, medical conditions, physical problems or limitations, or any medication your child uses. If there are none, please write n/a. *
Your answer
Is there anything else you would like the staff to know about your child?
Your answer
Authorized Pickups
Please list below people who are authorized to pick up your child (including parents). If this information changes, please send an email to kiersten@gvtheatre.org to release your child to the newly authorized person.
Authorized Person #1 Name *
Your answer
Authorized Person #1 relationship to student *
Your answer
Authorized Person #2 Name
Your answer
Authorized Person #2 relationship to student
Your answer
Authorized Person #3 Name
Your answer
Authorized Person #3 relationship to student
Your answer
Unauthorized Pickups
If necessary, please list who is not authorized to pick up your child below.
Name
Your answer
Relationship to Student
Your answer
Tuition Payment
Tuition for each semester is $90 per child ($125 for Conservatory students). Tuition is due by the first day of class. Need based scholarships are available. Visit https://forms.gle/c3UqodCKaJs1csxs5 to apply or contact kiersten@gvtheatre.org.
How will you be paying for your child's class tuition?
My child is permitted to appear in publicity photographs and speak with local reporters covering GVT's After-School Program in their community media coverage. *
I verify that all information provided above is correct. I understand that GVT Youth Education's primary form of communication is email and have provided accurate contact information. (Please type your full name as a form of electronic signature.) *
Your answer
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