Class Registration

Studio Registration

New Student Registration

Student #1: *
Birthday (mm/dd/yyyy): *
Age: *
Select Class:
Select Class:
Select Class:

Student #2:
Birthday (mm/dd/yyyy):
Age:
Select Class:
Select Class:
Select Class:

Student #3:
Birthday (mm/dd/yyyy):
Age:
Select Class:
Select Class:
Select Class:

Parent's Name: *
Address: *
City/Zip: *
Phone Number: *	(xxx-xxx-xxxx)
Email: *


Emergency Contact (other than parent): *
Relationship to Student(s): *
Phone Number: *

How did you hear about us?:
Referral Name:

TUITION POLICY Tuition is not refunded for missed lessons for any reason. Account statements will not be sent out unless your account is overdue. There is a $20.00 processing fee for all past due accounts. After the 10th of the month a $10.00 late fee will be added to your account and a past due invoice will be mailed to you. There is a $30.00 charge on all returned checks. If your account falls behind more than 2 months, you will be asked to pay your balance or your child’s enrollment may be canceled. In order to secure your child’s place in the class, payment must current.	I have read and understand the tuition policy
PAYMENT & WITHDRAWAL POLICY Your account will automatically be charged on the 5th of every month. If you do not wish to continue the class, you must notify the office by the 1st of the month or your account will be charged and no refund given. If you take a month off you may be required to pay a registration fee again when you return.	I have read and understand the payment & withdrawal policy.
REGISTRATION FEE A registration fee of $15.00 per new student ($25 per new family) or $10.00 per returning student ($20 per returning family) is required with the registration form to reserve your space in a class. (This fee is nontransferable and nonrefundable.) Class availability is on a first come basis. Registration is not complete until the registration fee is paid along with all proper forms signed.	I have read and understand the registration fee.
Release of Liability and Assumption of Risk I, the undersigned and/or being the legal and acting guardian representing a minor participant, hereby release, waive and discharge Lamorinda Theatre Academy its owners, directors, officers, employees, agents, independent contractors and volunteers from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Lamorinda Theatre Academy. I understand that activities as conducted and taught at Lamorinda Theatre Academy have inherent risks of injury. I recognize that the participant is exposing himself/herself to such risks when undertaking physical activities. I, the undersigned and/or being the legal and acting guardian representing a minor participant assume and accept all risks of injury or damages resulting from such activities.	I have read and understand the liability release and assumption of risk.
MARKETING RELEASE I understand that images of the participant may be used in Lamorinda Theatre Academy ads, promotional videos, website material, or various other marketing. These images will be used for Lamorinda Theatre Academy purposes only, and will not be given or sold to outside companies or individuals.	I have read and understand the marketing release.

Payment Method (check one):	Check Credit Card
Card Type:	VISA Master Card Discover
Name on Card:
Card #:
Exp Date (mm/yy):
3-digit security code:
Payment amount: *see TUITION RATE chart below and add $15 one time registration fee ($25 per family)
Comments:

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