Back to All About Music Children's Theatre

All About Music & Children’s Theatre  19108 Wolf Road Mokena, IL  60448  708-479-0440    

Acting Class Registration Form  (Please print)

Fall Acting Class   

$10 discount with enrollment in second camp or enrollment of additional siblings

Student’s Name:__________________________________________________________

Parent’s Name: __________________________________________________________

Address: _______________________________________________________________

City: __________________________________________ Zip: ____________________

Phone: ____________________________ Cell Phone: ___________________________

Parent email: ________________________________________

Student’s Grade in School: ______ Age: _______Date of Birth: ______/______/______

Shirt Size:  Child  6/8    10/12    14/16    Adult   Small    Med    Lrg    XL  Height ________  Pant/Short Size _________

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: ___________ Balance Due: ___________