ATYA Music and Drama - Registration 2023/2024

ATYA Music and Drama Registration 2023/2024

Complete and submit this form to complete your registration. *One per child
Student Information
Student Name: *

First NameLast Name
Current Age (Must be 5 years old by September 1st, 2023)*

567
Grade*

Kindergarten1st Grade2nd Grade
School Attending*
Please select the classes your child will be attending:*

PLAYTIME WITH BLUEY: April 20, 10am - 1pm, Grades K - 2, Cost $35
Parent Information
Parent/Guardian Information: *

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number:*
Please enter a valid phone number.
Work Number:
Please enter a valid phone number.
Parent Email: *
example@example.com
List all persons authorized to pick up student by FULL NAME as it appears on driver's liscense:*
How did you find out about this class (Check all that apply)?*

WebsiteFacebookInstagramNewsletterEmailInternet SearchBrochureNewspaperFriendCurrent StudentAttended Prior ClassOther
Are you receiving our newsletter?

YesNo
If no, would you like to be added to our mailing list?

YesNo
Health Information
Is your child in good health and able to participate in all activities?*

YesNo
If your child has any medical, physical or behavioral conditions that we should be aware of, please state them here:*
Please list any known allergies:*
Please list any medications being taken the staff should know about (OTC and Presciption): *
Emergency Contact Name:*

First NameLast Name
Relationship:*
Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com
Waiver
I grant full permission to the Sands Theater Center to use any photographs or video of theater activities for promotional purposes. I understand that all names and personal information of individuals will be kept anonymous on social media platforms.*

YesNo
I understand that tuition is due at time of registration and that my child's spot is not reserved until tuition has been paid.*

I agree
REFUND & CANCELLATION POLICY
- There are no refunds or credits for withdrawals made less than 72 hours in advance.
- Credits are valid for 6 months.
- All refund/credit requests must be made in writing to Angelyn@athensdeland.com.
The Athens Theatre reserves the right to alter or cancel scheduled programs as necessary. If a program is cancelled, a full refund of the cancelled program’s tuition is issued.
I understand the Refund & Cancellation Policy*

Yes
I hereby authorize my child to participate in activities sponsored by the Sands Theater Center Inc. In case of an accident requiring medical treatment, I authorize my child to receive such treatment as the attending personnel deem appropriate. I also agree to not hold the Sands Theater Center Inc. or persons acting on its behalf, responsible for injuries suffered by my child during activities sponsored by the Sands Theater Center Inc, including claims that I, or my family might have arising out of the negligence of Sands Theatre Center, Inc, its agents or employees. In consideration of the Sands Theater Center’s acceptance of my child’s enrollment, I hereby waive and release any and all rights and claims to damage against the Sands Theater Center Inc. *

Clear
Should be Empty:

ATYA Music and Drama Registration 2023/2024

Student Information

Parent Information

Health Information

Waiver