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All About Music & Children’s Theatre 19108 Wolf Road Mokena, IL 60448 708-479-0440 AUDITION CLASS Registration Form Tuition is $25 (Please print)
Student’s Name:__________________________________________________________ Parent’s Name: __________________________________________________________ Address: _______________________________________________________________ City: __________________________________________ Zip: ____________________ Phone: ____________________________ Cell Phone: ___________________________ Parent email: ________________________________________ Student’s Grade in School: ______ Age: _______Date of Birth: ______/______/______
Please list all medical or emotional conditions, allergies or medications we should be aware of:____________________ (use back) If parents can’t be reached, whom should we contact in case of emergency? Name: ________________________________________ Phone: (______)__________________ My son/daughter (Child’s name) _________________________________________________________ has my permission to participate in the All About Music, Inc. (Herein referred to as the Company) theater programs. As Child’s Parent or Guardian, I release the Company from any and all liability, damages, or claims whatsoever for any injury or harm that may occur to my Child while participating in any rehearsal, activity or performance provided by the Company. I agree that I will make no claim or demand against the Company if an injury or accident occurs during any rehearsal, activity or performance provided by the Company. I will look to my own resources, insurance or assets to pay all medical bills, damages or losses whatsoever if any injury occurs. The term Company includes all employees, subcontractors, volunteers or other staff of the Company participating in the camp. The Company may use any photographs or video taken of my Child while participating in the camp for publicity or promotion. I also give my permission to release my Child to the emergency contact listed above.
Parent (Guardian) Signature: _____________________________________________Date: _____/_____/____ Payment: Cash: ____Check #: ________________Amount: __________ |
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