Triple Threat Registration

Student One

First NameLast Name

Birth Date

MonthDayYear

Gender

Student Two

First NameLast Name

Birth Date

MonthDayYear

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian

First NameLast Name

Mobile Number

Work Number

Email

example@example.com

Parent/Guardian

First NameLast Name

Mobile Number

Work Number

Email

example@example.com

Emergency Contact

First NameRelationship to student

Email

example@example.com

Family Doctor

First & Last name Contact number

How did you hear about me? Please be specific.

I realize that there are risks involved in any activity or program and I acknowledge that my choice to participate or register my child/self at Theatre Street Music
& Performing Arts Studio brings with it the assumption of those risks. I am aware of no physical or other reason why the above-named students should not
participate in this program. I do hereby release, waive and forever discharge Theatre Street Music & Performing Arts Studio, its instructors and agents from
fault for injuries due to participation in this program or in any facility or location that this program is held. I also agree that if my child exhibits behaviors deemed
detrimental to the facility, the staff , other students or the Performance they will be removed from the program & Performance without refund.
By signing below, parents, guardians and students agree to abide by all rules, regulations, financial policies and procedures and expectations for behaviour for
Theatre Street Music & Performing Arts Studio.

Signature

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I acknowledge and agree to that classes, as well as the final show will be recorded. Photos may be used for advertising purposes with no compensation. A
video recording and or online link of the final performance will be available for sale to parents of students only.

Signature

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Parents : If you have any skills that you think would contribute to our Performance such as costuming, props, set building & design, etc wouldyou be willing to volunteer? Volunteers will be contacted in January.

YESNOOther

All program fees are non-refundable & non-transferrable.*

I understand

EMAIL MONEY TRANSFER

Select if paying by e-transfer and forward payment to theatrestreet@hotmail.com

CREDIT CARD, DEBIT OR PAYPAL

Triple Threat - 7 Month Program (28 Weeks)

$875.00CAD Quantity

Triple Threat - 7 Month Program (28 Weeks) Sibling

$825.00CAD Quantity

Enter coupon

Total

$0.00CAD

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.