After School Program Registration

After School Program Registration
Student #1: *
Birthday (mm/dd/yyyy): *
Age: *
 Select Program:
   
Student #2:
 Birthday (mm/dd/yyyy):  
 Age:  
Select Program:
   
 Student #3:  
Birthday (mm/dd/yyyy):
Age:
Select Program:
   
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 due in full by the first class. After the first day of class no refunds will be given. Payment plans are subject to a $25 fee. Deposits are non-refundable or transferable.

I have read and understand the tuition policy
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.
CASTING
I understand that my child's participation in this program is not dependent on or affected by the role he or she is cast in. No roles are precast. Casting is at the discretion of the director's and owners of the company, there is no guarantee your child will receive a role they request or prefer.
I have read and understand the casting policy.
 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:
Comments:
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