Download MUSICAL THEATRE WORKSHOP REGISTRATION 2016

MUSICAL THEATRE WORKSHOP REGISTRATION 2016-2017
Studio: 3817 Martinez Blvd. Augusta 706-231-1759 Mailing: 312 Rabun Valley Lane Martinez, GA 30907
Actor’s Name :__________________________________________________________________________________________
(as it should appear in the program and on the t-shirt)
YS(6) YM(8) YL(10)
DOB:_______________________________ Age:____________ T-shirt Size: (circle one)
AS AM AL XL 1XL
Address:________________________________________ Parent/Guardian Name:_____________________________
City/State/Zip:_________________________________ Relationship to Actor:________________________________
Home Phone:___________________________________ Cell Phone:_____________________________________________
**Email address: Most all communication is through email
______________________________________________________________________________________________________________
Emergency Contact :_____________________________________ Emergency Phone#:___________________________
Any medical conditions we should know about (allergies, asthma, etc.)? _____________________________
________________________________________________________________________________________________________________
CLASSES
Tuition/fees
SUBTOTAL
Registration Fee: $35 per family
*Production Fee: $200 for first child-due November 30th
$100 for each additional sibling
TOTAL PAID TODAY
DISCOUNTS:
Payment in Full Discount: When paying in advance for the full year tuition, there is a 10%
discount for Musical Theatre acting classes only. Full tuition paid by September 1st, 2016.
Military Discount: 10% on acting classes only
$10.00 late fee occurs after the 5th of each month tuition is paid. Nine months tuition
*Production fee includes, 2 tickets to upcoming production, a show tee shirt for each actor, one
personal ad per actor and costume help. This fee helps defray the cost of the theatre rental and use
of their technical equipment, royalties and script purchases. We depend on parent volunteers to
help build sets, find props and finish costumes. We also have a business/individual sponsorship
program to further defray theatre costs.
Participant Liability Waiver and Hold Harmless Agreement
Please read this form carefully and be aware that by registering for and participating in this program, or by
registering your minor children/ward for participation in this program, you will be waiving your rights and/or
the rights of your minor children/ward to all claims for injuries you or your minor child/ward might sustain
arising out of this program and you will be required to indemnify, hold harmless and defend Mrs. Mickey
Lubeck/MTW for any claims arising of the participation of _______________________________ in any activity (hereafter
referred to as “Program”) sponsored by Musical Theatre Workshops for all classes held at the studio as well as
at any venues that we shall be performing during the course of the year.
Risk of Injury: As a participant in the program, or as a parent or legal guardian of a participant under 18 years of
age, I recognize and acknowledge that there are certain risks of personal injury involved with participation in
the Program, and I agree to assume the full risk of injuries, damages or loss which I or my minor child/ward
may sustain as a result of participating in any and all activities associated with this program.
Waiver of Injury Claims: I agree to waive and relinquish any and all claims I may have arising out of, connected
with, or in any way associated with the activities of the program.
Release from Liability: I do hereby fully release and discharge Musical Theatre Workshops and its officers,
agents and employees from any and all claims from injuries, damage or loss which I or my minor child/ward
may have or which may occur on account of participation in the Program.
Indemnity and Defense: I further agree to indemnify, hold harmless and defend Musical Theatre Workshops and
its officers, agents and employees from any and all claims from injuries, damages and losses sustained by me or
my minor child/ward and arising out of, connected with, or in any way associated with the activities of the
Program.
Medical Emergencies: In the event of any emergency, I authorize Musical Theatre Workshops to secure from
any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor
child/ward’s immediate care and agree that I will be responsible for payment of any and all medical services
rendered.
PHOTO and VIDEO RELEASE:
You have my permission to use any theatre studio pictures or video of my child taken either during class time
or during performances for the purposes of illustration, advertising, promotion, display, or publication, and for
any other lawful purpose. I understand that I will not be paid for the use of my child’s photos.
Photos may be used on Facebook or Youtube but no names will be released.
Tuition and Production payments:
All tuition payments are due before the 5th of each month of classes. August and May tuitions are
halved. A $10 late fee is incurred after the 5th of each month that tuition is paid.
All actors are expected to participate in the spring musical productions with their class. All families are
expected to participate/volunteer in either a backstage/lobby duty or festival booth duty during the course of
the workshop season. If an actor wishes to withdraw from the workshops at some point in the year, a two week
notice needs to be given, and all tuition needs to be paid to date.
Conduct:
All actors are expected to respect their fellow actors and their instructors in all their classes. If any disruptive
behavior becomes problematic, the director of the program will dismiss the actor from their classes and no
refund of tuition will be made.
I have read and fully understand and agree to the above stated conditions of participation in the Program.
Print name of Parent/Legal Guardian____________________________________ Date: _____________________________________
Signature Parent or Legal Guardian ___________________________________________________