Imagine! Play! Act!- with Ernaisja Curry
This class is PAY WHAT YOU CAN and was created for 4th-6th grade students

All classes will take place Saturdays from 9:30am-11:00am
November 11, 18, 25
December 2, 9, 16

Registration Information
Student's Last Name *
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Student's First Name *
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Student's Cell Phone Number (if available)
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Parent 1 Last Name *
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Parent 1 First Name *
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Parent 1 Phone Number *
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Parent 2 First Name
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Parent 2 Last Name
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Parent 2 Phone Number
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Best email address to reach you and your family *
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Additional email address to reach you and your family *
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Age of student *
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Grade of student *
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Where does your student attend school? *
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How did you hear about our acting programs? *
Health and Emergency Information
All answers will be kept private and confidential
Does your student have any allergies? *
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Does your student have a medical history, existing medical condition, or a learning disability that we should be aware of? *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Additional Emergency Contact Name *
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Additional Emergency Phone Number *
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Liability Release
Liability Waiver --- I hereby release Know Theatre of Cincinnati and its instructors from any responsibility for injury to my child(ren) or myself while partaking in this class, or during the journey to and from the location of the class. The person filling out this form, a parent or guardian of the above-entered child(ren) under the age of 18, hereby assumes all responsibility for injuries which may result from normal activities for the above program(s) for which child(ren) is/are participating in and hereby releases Know Theatre of Cincinnati and its instructors for any such responsibility.
I am the person attending or the parent or guardian of the child attending and I accept the terms above *
Payment
Payment can be made by calling the theatre, 513-300-5669, or giving a check to the instructor.
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