FVCT Holiday Show Registration Form
Please complete this form to enroll your child in HAPPY HOLIDAYS 2017 with Michael Berkeley. There is a materials fee of $125 and checks may be made payable to "FVCT" and mailed to: The Center on Main, 103 Main Street, Falls Village, CT 06031. (Program is subject to minimum enrollment.)

HAPPY HOLIDAYS! Rehearses Sundays, October 15 - November 19, Saturday, November 25, most afternoons the week of the show, and some additional weekdays to be decided.

Performances Dates: Friday, Dec. 1 at 7 pm, Saturday, Dec. 2 at 7 pm, and Sunday, Dec. 3 at 1 pm.

Student's Last Name
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Student's First Name
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Nickname (if any)
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Date of Birth
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Grade
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School
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T-Shirt Size
Parent/Guardian Name
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Address
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Home Phone
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Work Phone
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Cell Phone
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Additional Phone Numbers
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Parent Email 1
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Parent Email 2
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Name and relationship of contact in case of emergency when parent/guardian cannot be reached:
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Phone 1 of Emergency Contact:
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Phone 2 of Emergency Contact:
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Please list any allergies, medical conditions, or other important information we should know about your child.
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Child's Physician
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Physician's Phone
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Your name printed below serves as your signature granting the following Medical Emergency Release: Medical Emergency Release: I authorize the Falls Village Children’s Theater Company to administer care and treatment for injuries and/or illnesses for my child that may occur while in session. I authorize the release of information and medical records to facilitate the medical, surgical or psychiatric care of my child. In the event of an emergency, illness or injury in which a delay may jeopardize the life of the recovery of my child and I am unable to be contacted, I authorize the Falls Village Children’s Theater Company and/or its representatives, instructors, volunteers or staff to assume responsibility for the care and treatment of my child which many include hospitalization, diagnostic tests and/or surgery.
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Your name printed below serves as your signature giving approval for this Participation Release: I/We, the parent(s) of the above named child(ren), hereby give approval for him/her/them to participate in any and all activities of the Falls Village Children's Theater Company and do hereby waive, release, absolve, indemnify and agree to hold harmless the Falls Village Children's Theater Company, all organizations, all organizers, all instructors, volunteers, officers, directors, sponsors, supervisors, participants and persons involved in the Falls Village Children's Theater Company, for any claims arising out of any injury, including transportation to and from activities, to my/our child(ren) whether the result of negligence or for any other cause. This release holds true for my child(ren) as well and myself/ourselves.
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Your name printed below serves as your signature and grants permission for your child’s photo to be taken and used, possibly, to publicize other FVCT theatre camps, classes and workshops. In addition, your signature gives permission for the FVCT to videotape rehearsals and performances, when allowed.
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Your name printed below serves as a signature agreeing with the following: The Falls Village Children’s Theater Company reserves the right to dismiss students for behavioral issues. Our instructors strive to insure a fun and educational experience for all of our students. A dismissal due to behavioral issues is highly unlikely. Your signature below serves as acceptance of this policy.
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