Registration Form
Fall 2010
Please fill in all starred fields *
	Participant *
	Show *	--Fall 2010-- For complete descriptions and details, please visit our Classes Page H.O.P.E. Location - Ralston Road and Garrison Street A Midsummer Night's Dream Shakespeare to Go! Creative Drama A Little Princess Creative Drama: ACT Courageous Alice in Wonderland Writing for Actors Omelette: Chef of Denmark Anything Goes Pre-Ballet Beginning Ballet Ballet - Teens and Adults Learn to Sew! School of Rock Beginning Swing and Foxtrot Performance Ballroom Dance Aurora Location - Dartmouth and Laredo Comic Book Artist Broadway Bound: Songs and Scenes from Popular Musicals
	Age *
	Grade *
	Birthday *
	Parents or Legal Guardians
	Street Address 1 *
	Street Address 2
	City *
	State *
	Zip *
	Phone *
	Alternate Phone
	Alternate Phone Type
	Email
	Referred By
	Physician *
	Physician Phone *
	Emergency Contact *
	Emergency Phone *
	Medical Comments
	Student Name *
	Parent or Legal *
	Date *
I understand that there are inherent risks involved in the variety of theatre activities in which my child will participate during the Actor's Company and Theatre School program. I recognize and accept that participation in any theatrical activities such as performing on set platforms and staging has obvious and necessary risks. By submitting this waiver, I state that my child is in proper physical, mental, and emotional condition to participate in all activities. I waive right to any and all claims that I may have against the owner(s) of the rental space and Actor's Company and Theatre School and its faculty and staff for any injuries or accidents my child may suffer as a result of his/her participation in therein. I understand that in the event of an emergency when I cannot be reached, permission is hereby granted to Actor's Company and Theatre School to secure medical treatment for my child. I give permission for an emergency physician to treat the person named in this registration form. I accept responsibility for all medical expenses incurred.