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Please complete a separate form
for each child: this form may be photocopied. A non-refundable registration
fee of $50 which applies to the tuition fee must accompany this form.
Full payment by cash or check is required on or before the first class
day. Please return this form along with the Parent/Student Agreement/Medical
Release form, and your check to:
|
| M.
Vanlandingham PO Box 20991 Waco TX 76702 |
| For information, please call Linda Haskett (254)-776-0707 or Mary Vanlandingham (254)-772-5779 |
| Student’s Name_____________________________________ M/F_______________ |
| Address______________________________________________________________ |
| City____________________State_____Zip________ Phone____________________ |
| Age_____ Birth date___________ Grade Fall 1999_____School________________ |
| Mom’s Name_________________________Dad’s Name_______________________ |
| Mom’s Employer_____________________Dad’s Employer____________________ |
| Mom’s Work Phone__________________ Dad’s Work Phone__________________ |
| Mom’s Pager/Cell____________________ Dad’s Pager/Cell___________________ |
| Fax number_________________________ |
| E-mail addresses______________________________________________________ |
| T-Shirt Size (Circle) YOUTH ADULT S M L XL XXL |
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Session A June 7 - 18 Ages 6 & 7 9 am - 12 noon $125 $___________ |
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Session B June 7 - 18 Ages 8 - 17 9 am - 3:30 pm $225 $___________ |
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Session C June 21 - July 2 Ages 6 & 7 9 am - 12 noon $125 $___________ |
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Session D June 21 - July 2 Ages 8 - 17 9 am - 3:30 pm $225 $___________ |
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Session E June 7 - July 10 Evening rehearsal and performance of $ 75 $___________ |
| JOSEPH & THE AMAZING TECHNICOLOR DREAMCOAT |
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OPEN AUDITIONS JUNE 7, 6:30 PM
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Multiple session registration is discounted $25 per child ...........TOTAL
$_________
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Student Agreement
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| I will abide by C A S T rules and regulations. I will also respect the authority of the directors, teachers and staff members during my stay. |
| Student’s Signature_______________________________________________________________ |
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Parent Agreement
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| I give permission for my child to participate in any and all activities. I will not hold C A S T Children’s All Star Theatre, any individual staff member, or any directors responsible for any accidents incurred during the 1999 sessions. Furthermore, I understand that I will be financially responsible for damages to property resulting from actions by my child. Any disciplinary problems will be handled on an individual basis, and very serious problems may result in dismissal. |
| Parent’s Signature__________________________________________ |
| Please list any medical problems, allergies or learning differences:__________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ |
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MEDICAL RELEASE
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| In case of an accident or sudden illness to my child at C A S T, a theatre-related activity, and in transportation to or from said activity, and in the event that I cannot be reached by telephone, I hereby authorize a representative of C A S T to refer the child to my physician or to the best available medical facility at the time and to consent to medical treatment. I agree to indemnify and hold such representatives of C A S T harmless from any claim connected with such referral or transportation for medical treatment, or to my home, by theatre personnel, or its authorized representative. |
| SIGNED________________________________ DATE________________ |
| RELATIONSHIP TO STUDENT____________________________________ |
| PHYSICIAN_____________________________PHONE_______________ |
| This site designed by The Pixel Pixie Design Company, designer Kelly Howard. |