Acting Up Club Registration
Fall 2019 Session
Child's Information
Child's Name *
Your answer
Current School Grade *
T-shirt Size *
Allergies/Special Needs
Your answer
Parent/Guardian and Contact Information
Parent/Guardian Name *
Your answer
Streeet Address *
Your answer
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number (where you can be reached) *
Your answer
Please select one or more teams where you can volunteer. Volunteers make Acting Up Club happen! (No experience necessary; state clearance may be required for certain roles)
Consent for Participation and Medical Release
I give permission for my child to "Act Up" for the next 13 Wednesdays beginning Sept. 11, 2019. The musical, "The Secret of Snowflake County," will be performed on Saturday, December 7th and Sunday, December 8th, at 6:00 PM. Final rehearsal will be Saturday, December 7th, from 10:00 AM - Noon. *
I give permission for my child to be photographed and/or recorded on video. *
I give my permission for the SHCN Acting Up Club staff to administer basic first aid to my child in the event of an injury. I understand that staff will contact emergency services (911) in the event of a significant injury and all expenses for such emergency services will be paid by me. *
Registration Fees
If paid before September 11th: $20
After September 11th: $25

Please make all checks payable to: SHCN (Acting Up in memo)

If you have any questions, please contact Ms. Cathy:
Phone Number: (412) 841-7440
Email Address:
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