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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 ___________________________________________________