Class Registration

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Class Registration Student Information

Student's First and Last Name: *

Preferred Name (for Name Tag)

Age: *

Gender Male Female *

Are you a NEW or RETURNING student to ACT? *

Returning Students: Have you lost your binder?

Does this student have a disability or special needs? *

If YES, please descibe this student's disability or special need. (ADD, ADHD, Asperger's, Sensory Issues, Developmental Delay, Epilepsy, etc) We can best help your child succeed if we know his/her background.

Class Selections

AGES 4 - 6 Class

AGES 6 - 9 Class

AGES 9-12: FOUNDATIONS SEMINARS

AGES 9-12 Class

AGES 9-12 Additional Class

AGES 13-19: FOUNDATIONS SEMINARS

AGES 13-19 Class

AGES 13-19 Additional Class

Parental Consent

Parents' Names: *

Street Address: *

City: *

State: *

Zip: *

Best Phone: *

Alternate Phone (Do NOT list the same number again): *

E-mail Address: *

Medical Release

In the event of an emergency, I understand that a reasonable effort will be made to contact me. If I cannot be reached, I hereby authorize an agent of the Academy of Children’s Theatre (ACT) to act on my behalf to seek emergency medical treatment for my child, listed above, in the event that such treatment is deemed necessary by that agent. I authorize the physician selected by said agent to administer such emergency treatment as said physician deems necessary (in his/her judgment) under the circumstances. I understand and agree that I will be responsible for payment of said physician's fee and any and all other fees or expenses associated with such treatment. I hereby release the ACT, its agents and employees from any and all claims and liabilities resulting from participation with ACT-sponsored activities.

Parental Consent

Parent/Guardian Signature - by filling your name, you confirm that you agree to the medical release and have the legal right to sign for medical treatment of the aforementioned minors. *

Date: *

Publicity Waiver

Unless informed otherwise in writing, the Academy of Children's Theatre (ACT) considers photographs taken of students and their work in class and in performance to be permissible for publication in ACT marketing materials and in informational publications, including our website.

Refund Policy

Cancellation 3 weeks or more before class starts: Tuition refunded, minus a $25 admin fee.

Cancellation up to 3 weeks before class starts or after first class: Tuition will be refunded, minus a $50 fee.

Cancellation after second class: No refund will be given.

I have read and understand ACT's refund policy. *

Feedback

Message to ACT:

How did you hear about ACT?

Note:

A tuition deposit is due as you register. When you click on submit, you will be directed to a payment page to make the deposit via Paypal.com, which is a secure site where you can pay by credit or debit card.

Registrations submitted without payment will NOT be reserved.

There will be a $30 fee for any bounced checks, balance transfers with insufficient funds, or credit card charge backs.

Thank you for registering for an ACT Class!

PayPal Tuition Depost Payment

PayPal Tuition Depost Payment
Class Deposit of $50

Foundations Seminar Payment of $20