Act One School of Drama 2021-22 Course Registration Form

Act One 2021-22 Class Registration Form

Please note that fields with red asterisk are mandatory.
Student Name *

First Name Middle Name (Optional) Last Name
Student Age *
(Age as of September 1, 2021)
Birth Date *

Month Day Year
Gender *
(Please indicate how student identifies themselves)
Has the student participated in a drama program before?
((Please note: this is solely for more effective instructor class planning. Prior experience does not influence individual student acceptance into any Act One program)
2021-22 Classes: (Please select all that apply) *

Theatre for Ages 8-9: Mondays 5:00-6:30pm Theatre for Ages 12-13: Mondays 6:30-8:00pm Adult Theatre for Ages 19+: Mondays 8:00-10:00pm Early Years Theatre for Ages 3-4: Tuesdays 5:00-6:30pm Acting On Camera for Ages 11-13: Tuesdays 6:30-8:00pm Acting On Camera for Ages 14-18: Tuesdays 8:00-10:00pm Theatre for Ages 10-11: Wednesdays 5:00-6:30pm Theatre for Ages 12-13: Wednesdays 6:30-8:00pm Theatre for Ages 14-18: Wednesdays 8:00-10:00pm Theatre Basics for Ages 5-7: Thursdays 5:00-6:30pm Improvisation for Ages 12-13: Thursdays 6:30-8:00pm Improvisation for Ages 14-18: Thursdays 8:00-10:00pm Vocal Program for Ages 7 to Adult: Friday Lesson Slots 3:30-9:00pm Theatre for Ages 10-11: Saturdays 9:00-10:30am Theatre for Ages 8-9: Saturdays 10:30am-Noon Theatre Basics for Ages 5-7: Saturdays Noon-1:30pm Theatre for Ages 12-13: Saturdays 1:30-3:00pm Directing for Ages 16-18: Saturdays 4:30-6:00pm Musical Theatre for Ages 7-10: Sundays 11:30am-1:00pm Musical Theatre for Ages 11-13: Sundays 1:00-3:00pm Musical Theatre for Ages 14-18: Sundays 3:00-5:00pm Improvisation for Ages 14-18: Sundays 7:00-9:00pm
Class Registration Special Notes/Other information:
Please enter any other information relevant to the student registration (ie multiple class selection for purpose of deciding between multiple classes as opposed to taking both, etc)
Applicable General Program Discounts:

Attended previous Act One Theatre Summer Camp Session (5% Discount) Returning Act One Student (5% Discount) Attended previous Act One March Break Camp (5% Discount) 2nd or 3rd Member of Same Family (10% Discount for each additional member) Registering in more than one class in 2021-22 (10% discount off each class after first)
Referral Discount Section: (If this section applies, please specify applicable names in box below)

I was referred by another Act One student/camper (5% Discount) I am referring other student(s) who will be attending in 2021-22 (5% Discount per student)
Name of person who referred student or of other student(s) being referring by this student:
If being referred by or referring other students, please enter name of student who referred you or the new student(s) you have referred to the school in the comment box above. Referral discounts are applied when the other student(s)registrations are confirmed. Please note that it is possible to select both referral boxes above. If this is the case, please identify which students are referring or being referred.
Home/Mailing Address *

Street Address

Street Address Line 2

City Province

Postal
Home Phone Number
Parent/Guardian Contact 1: Name *

First Name Middle Name (Optional) Last Name
Parent/Guardian Contact 1: E-mail *
example@example.com
Contact 1 Relationship to Student *
Parent/Guardian Contact 1 Phone#: *
Phone Type: *

Mobile/Cell Work Home Other
Parent/Guardian Contact 2: Name

First Name Middle Name (Optional) Last Name
Parent/Guardian Contact 2: E-mail
example@example.com
Contact 2 Relationship to Student
Parent/Guardian Contact 2 Phone#:
Phone Type:

Mobile/Cell Work Home Other
Special Medical Requirements and/or Other Condition Notes: (Please put "None" if there is nothing we should know about) *
To better help the instructors with class preparation and to ensure student comfort and safety, please let us know if the student has any special medical, disability or other conditions that we should take into account when planning for the student's class experience.
How did you learn about the school? (If you answer "Other", please identify source in Comment section provided)

Internet Search (ie Google, etc) Act One School Website Current or previous Act One student or camper City of Pickering Recreation Brochure City of Ajax Recreation Brochure From a friend or colleague Facebook Ad or Page Other
Act One E-Mail Communication Policy

Act One relies primarily on e-mail communications. Canadian law now requires that organizations obtain the permission of their clients to communicate via e-mail. Act One uses e-mail to send school and student information in the most efficient, timely and effective manner possible. From time to time, Act One will also send various students communications on relevant upcoming events, opportunities (ie. auditions, etc) and other school information. Act One will never provide third-party organizations with any contact information of its students or their families, nor will we allow direct third party-to-student communications. Any such contact will only be sent directly by Act One and only after Act One has reviewed the proposed third party communication to ensure it is of potential interest and/or benefit to Act One students and/or their families.
E-mail Communication Acceptance: *

I grant Act One permission to communicate with me via e-mail for a period of up to 24 months from this date I wish to make other communication arrangements. (Please note: if selecting this option we can not process your registration until another communication arrangementhas been established. Please specify details below.)
Name of Person Completing Registration Form: *
(Must be same person who answers Student Release below)
Act One Student Release Waiver

I agree that, having taken such precautions as Act One (the School) deems advisable, the School and school staff will not be held responsible for any sickness or accident to the student, no matter how caused. If for any reason the student requires medical attention, I agree to be responsible for any expense incurred. I covenant and agree to indemnify the School, its employees and staff and save them harmless from and with respect to all suits, actions and claims by reason of any activity carried out by the student, whether on or off the School's property. I, the undersigned, have read and fully support this Student Release.
Student Release Acceptance: *

Yes, I accept the Student Release No, I do not accept the Student Release (Please note we can not process a registration in this case)
Should be Empty:

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Act One 2021-22 Class Registration Form