Apollinaire Play Lab summer 2022
Class Registration Form
Classes July 11 - 29 • Performances are August 5, 6, 12, 13, 19, & 20
Classes run July 11 - 29, Mon.-Fri., 9:00am-12:00. Rehearsals are August 1 & 2 from 6:00pm-9:00, and August 3 & 4 from 6:30pm-9:30. Performances are August 5, 6, 12, 13, 19, & 20 in Chelsea Square and students will be there 7:00pm-9:30.
And Your Little Dog Too • Y Tu Perrito También
Students will be a part of our professional company's production of "And Your Little Dog Too • Y Tu Perrito Tambien" an original bilingual adaptation of The Wizard of Oz! Class time will include art, acting, dance and singing to prepare them to be featured in key scenes! The classes are for ages 6-11. Youth 12-16 can apply to be program mentors by first sending an email stating their interest to: apl@aplaylab.com
Student's Name:
*
First Name
Last Name
Will you be adding a sibling/s?
*
Yes
No
Parent or Guardian's Names/s:
*
Address
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Alternate Phone Number
Email
Additional/Alternate Email
Date of Birth
Age
Grade
Primary Language
Secondary Language
Does your child have any special needs? Physical, learning, health, developmental, etc.
I have reviewed the schedule in detail and my child is able to make all of the dates and times for classes, rehearsals, and performances
*
Yes
No (please provide details below)
Please provide details if your child is unable to make all classes, rehearsals, and performances. This may impact your child's ability to take part and you will be contacted if this is the case.
If your child is 10 OR OLDER and you would like to give them permission to walk home themselves after their class/es, please indicate so here:
*
N/A- my child is under 10
YES, I do give permission for my child to walk home themselves
NO, my child does not have permission to walk home themselves and a parent/guardian will pick them up
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Sibling's Name
*
First Name
Last Name
Date of Birth
Age
Grade
If any parent/guardian information is different, or any contact information is different, please specify here.
Does your child have any special needs? Physical, learning, health, developmental, etc.
I have reviewed the schedule in detail and my child is able to make all of the dates and times for classes, rehearsals, and performances
*
Yes
No (please provide details below)
Please provide details if your child is unable to make all classes, rehearsals, and performances. This may impact your child's ability to take part and you will be contacted if this is the case.
If your child is 10 OR OLDER and you would like to give them permission to walk home themselves after their class/es, please indicate so here:
N/A, my child is under 10
YES, I do give permission for my child to walk home themselves
NO, my child does not have permission to walk home themselves and a parent/guardian will pick them up
I will be adding another sibling
*
Yes
No
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Sibling's Name
*
First Name
Last Name
Date of Birth
Age
Grade
If any parent/guardian information is different, or any contact information is different, please specify here.
Does your child have any special needs? Physical, learning, health, developmental, etc.
I have reviewed the schedule in detail and my child is able to make all of the dates and times for classes, rehearsals, and performances
*
Yes
No (please provide details below)
Please provide details if your child is unable to make all classes, rehearsals, and performances. This may impact your child's ability to take part and you will be contacted if this is the case.
If your child is 10 OR OLDER and you would like to give them permission to walk home themselves after their class/es, please indicate so here:
N/A, my child is under 10
Yes, I do give permission for my child to walk home themselves
NO, my child does not have permission to walk home themselves and a parent/guardian will pick them up
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Payment
Will you be
•Paying Full Price
•Using the EBT Culture Card
•Applying for Scholarship or Payment Plan (no EBT card)
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Apollinaire Play Lab
Payment
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( X )
Full Price - one child
$
475.00
Full price- add a sibling/s
$
195.00
Number of siblings adding
1
2
EBT Card for Culture
$
95.00
EBT Card for Culture- add 1 sibling
$
75.00
EBT Card for Culture- add a second sibling
$
50.00
Total
$
0.00
Credit Card
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Scholarship Application
For families requesting scholarship without an EBT card.
Student's Name:
First Name
Last Name
Amount your family can contribute towards tuition:
Are you applying for a payment plan?
Please give a brief description of the family's financial situation:
Anything else we should know:
Once your application has been reviewed, we will contact you to confirm the scholarship amount that has been approved and to arrange for payment.
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Program Expectations & Release Form
Apollinaire Play Lab classes are designed for motivated student actors and artists. Participants who are not able to focus their energy on the work of the class and contribute to the progress of the group will be asked to leave the program.
Students are expected to attend all classes, except in the case of illness, exposure to Covid, or presentation of any Covid symptoms.
Please call or email when your child will miss a class due to illness.
Students must be dropped off and picked up before and after class. The only exception is those students 10 years of age or older who have been given express permission in this form to walk home themselves. Students may not wait unattended while other classes are in session.
Photo Release:
Occasionally, we take photographs of students during classes and performances at Apollinaire Play Lab. We may use these images in print publications that we produce, as well as on our website, or on display boards at the studio. Images may also be used for newspaper advertisements or press releases. We will not use personal details of any person in a photographic image without prior specific permission not covered by this consent form. By submitting this form you consent to use of photographic images.
Covid Safety
Masks are required at all times in the Riseman Family Theatre during Apollinaire Play Lab classes. If your child is presenting with any symptoms, they need to not attend. Classes missed due to illness are not counted as absences. Precautions we are taking in addition to mask-wearing include: our staff is vaccinated, frequent sanitation, air purifiers, and hand sanitizer. We encourage all eligible students to be vaccinated against COVID.
Illness:
If a child should become ill while attending the program, the parent or designated emergency contact will be notified immediately. It remains the responsibility of the parent to provide transportation for the child.
Accident:
In case of accident I agree to hold TheatreZone, Inc. dba Apollinaire Theatre Company and Apollinaire Play Lab and its instructors blameless and to refrain from legal action.
I understand that if a participant is unable to participate for any reason, or is asked to leave the program due to unsatisfactory attendance (absent more than 2 classes), tardiness, or disruptive conduct, the class fee will not be returned.
Further, I hold TheatreZone, Inc. dba Apollinaire Theatre Company and Apollinaire Play Lab and its employees in no way liable for any damage sustained to my child or his/her property while participating in the Apollinaire Play Lab Program.
By submitting this form, I accept the terms and conditions of enrollment for my child described above.
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Apollinaire Play Lab
Riseman Family Theatre • Chelsea Theatre Works, 187 Winnisimmet St. Chelsea, MA • apl@aplaylab.com • 617-615-6506 •
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