Civic Theatre School Summer 2017 Registration

Civic Theatre School Summer 2017 Registration

 

Click Here for Class Schedules, Descriptions, and Tuition Information

Click Here for Scholarship Information

 

Register ONLINE:

  1. Complete the Registration Form below.
  2. Once you SUBMIT the Registration Form, you should automatically be sent to the Payment Section. If not, click on the Payment Section at the bottom of the page to complete the process.

Registration Form

* fields are required!

Student Information
Student Name*
Age*
Gender*
Birthdate*
Grade in Fall 2017* School*

Mailing Address*
City* State* Zip*

CTS Summer 2017
Session (All Grades)*:
Half Day or Full Day (Grades 3-8 Only)*:
Voice Option (Grades 9-12 Only)*:

Primary Parent/Guardian Information
Name*
Email*
Cell Phone*
Relationship*
Is your mailing address the same as above?*

Secondary Parent/Guardian Information (if applicable)
Name
Email
Cell Phone
Relationship
Is your mailing address the same as above?

Please complete the following ONLY if the person paying for tuition is different from a Parent/Guardian listed above.
Name
Email
Cell Phone

Medical/Emergency Information
In Emergency Notify:
Name*
Relationship*
Phone*

Name of Family Physician/Practice*
Phone*
Family Medical/Hospital*
Health Insurance Carrier*
Policy Number*
Group Number*

Does your child have a diagnosed physical or mental condition/disability that requires an accommodation?*

If yes, please describe and indicate accommodations needed:

Is there any information that would be useful to the adult in charge including medical conditions and any activities to be encouraged or restricted?*

If yes, please describe in detail:

Allergies?*

If yes, please describe:

Cancellation Policy
If a student cancels enrollment, refunds will be given as follows:
Up to two weeks prior to start of class: Full Refund
Two weeks prior to the start date of class: Full Refund minus $20
During week prior to start date of class: 50% Refund
Start Date or any time thereafter: No refund

Liability Release/Authorizations
- I understand this form must be completed for CTS Fall & Winter Session(s) and I will be required to update it every CTS session.
- Understanding that all necessary precautions for safety will be taken, I release the staff and Civic Theatre of Allentown, PA from any liability for injury that my child may sustain while involved in any aspect of his/her participation at Civic Theatre.
- I understand Civic Theatre of Allentown maintains no insurance coverage that applies to injuries sustained by students and volunteers, including volunteer performers. I acknowledge that my child’s participation in this production or activity is at our own risk.
- I hereby indemnify and hold harmless Civic Theatre of Allentown, PA, its staff, employees and officers from any and all claims which may be made as a result of any injuries sustained by my child as set forth above.
- I hereby certify that my child does not have any medical condition or allergic condition which would preclude his/he participation in volunteering or working at Civic Theatre classes, rehearsals or productions. I give permission to the staff of Civic Theatre of Allentown to administer first aid or to seek medical treatment for my child. I understand that if an emergency occurs and the local police or other similar authorities take custody of my child, Civic Theatre of Allentown cannot guarantee that my instructions stated will be followed (i.e. Hospital of preference).

I, the custodial parent/legal guardian give my (our) permission for:
1. Civic Theatre to use any photograph or video/audio recording in which my child appears for promotional purposes.
2. My/our child to receive medical treatment by a teacher, first-aider, EMT, nurse, doctor or hospital if necessary. It is understood that the adult in charge or her/his designate will attempt to contact me.

By checking this box and initialing below, I agree to the Liability Release/Authorization for my student to attend Civic Theatre School.
Initials

 

Click here to proceed to the Payment Section.

Registration will not be complete until payment is processed.

If you have any questions, please call Zack Einstein at 610-433-8903 x202