THEATRe programming summer 2022
Rhode Island Youth Theatre
Student Name (How it will appear on the program)
How many students are you registering? (20% discount for siblings)
Sibling 1 Name (How it will appear on the program)
Age: Sibling 1
Sibling 2 Name (How it will appear on the program)
Age Sibling 2
Street Address Line 2
State / Province
Postal / Zip Code
Parent or Guardian Name 1:
Parent or Guardian Email 1:
Parent or Guardian Name 2:
Parent or Guardian Email 2:
Emergency Contact Phone:
If answer is yes, please explain.
Dismissal - Will the student be signed out each day?
If Answered yes, by whom? (ID required)
Any custodial or medical Issues?
Does your child do gymnastics?
If answer is yes, please list what tricks they have permission to do at rehearsal and in shows.
Photo Release: Do you give your permission for your child's photo to be used for promotion material for RIYT?
What program are you registering for?
( X )
Music Man Jr. THEATRE PROGRAM Aug 8th-20th at The Historic Park Theatre
Credit Card Details
Credit Card Number
Liability Release/Emergency Treatment: I certify that my child may tolerate all normal physical activity. I, the undersigned parent/guardian grant permission for my child to receive the necessary medical treatment in the event s/he sustains an injury or illness during my absence. I understand that if my child has a medical condition that requires an assigned assistant in a school setting, then either I or the child’s assistant must be present at all times. I acknowledge and understand that participation in this activity presents the possibility that my child may sustain physical injury or illness. I hereby release Rhode Island Youth Theatre, its employees, officials, and agents from any liability connected to my child’s participation in the program. -Parent/Guardian Signature
Should be Empty: