Build a Beast (Adult)
Class Registration
Full Name
*
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Age
*
Emergency Contact Information
Contact Name
First Name
Last Name
Relationship to Applicant
Phone Number
*
Please enter a valid phone number we can use to contact you.
Optionally, let the instructor know anything you think may be of concern or interest during the camp (ie allergies, medical conditions, performing history, etc)
Release Form
Give Prescott Center for the Arts permission to share photos or video of you involved in promotion of the program.
I hereby assign and authorize Prescott Center for the Arts all rights in and to photography / recording of me during production of this show. I authorize Prescott Center for the Arts, without limitation, the right to edit, reproduce, copy, exhibit, publish or broadcast any such photography or recording, and waive all claims I may have against said organizations and / or any of their affiliates, subsidiaries or assignees other than stated in this agreement.
*
I agree
Digital Signature
*
Clear
SUBMIT
Should be Empty: