Palmer 2025 Finding Nemo

Child's name/Grade

Name of Grown-up 1

Email of Grown-up 1

Phone of Grown-up 1

Name of Grown-up 2

Email of Grown-up 2

Phone of Grown-up 2

Mailing address

Emergency contact (name and phone number of someone other than previously listed grown-ups)

Costume information (size in numbers and letter)

List any allergies or special needs:

I hereby give permission for images of my child, captured during Palmer Middle School Drama Club through video, photo and digital camera, to be used solely for the purposes of Little Actors’ Studio promotional material and publications, and waive any rights of compensation or ownership thereto.

Signature

I grant my authorization and consent for Amber Lopez and/or Alex Lopez (hereafter “Designated Adults”) to administer general first aid treatment for any minor injuries or illnesses experienced by my child. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designated Adults to summon professional emergency personnel to attend, transport, and treat the minor. I agree to assume financial responsibility for all expenses of such care.

Signature

Exemplary attendance and behavior is expected of my child, and he/she may be removed if, in the sole discretion of Little Actors’ Studio, my child does not meet these standards.

Students with parents, guardians, or family members who are disruptive or do not maintain appropriate and positive working relationships with the staff of Little Actors’ Studio, may also be removed at the discretion of the director of Little Actors' Studio.

An 80% refund of participation fees will be given if the student decides not to continue the program before February 3, 2025.

Refunds of participation fees will not be granted at any time for students who are removed because of poor attendance or behavior.

Refunds of participation fees will not be granted for students who voluntarily leave the program because they are dissatisfied with the role they are given. These students will also not be admitted back into the program at a later date.

Absences will be excused if the student stayed home from school the day of practice due to illness. After three unexcused absences, it will be the sole decision of the director of Little Actors' Studio as to whether you will be kept on as a cast/crew member.

This program is not sponsored or run by Palmer Middle School, or the Cobb County School District. Little Actors’ Studio takes full responsibility for this program and all related activities. All questions or concerns regarding this program should be directed to Little Actors’ Studio and Amber Lopez.

My Products (Check a box if you intend to pay via PayPal. Otherwise do not check a box. Be certain to click "Submit")

PayPal payment

$285.00

PayPal payment teacher/siblingThis reflects a 10% discount.

$256.50

Total

$0.00

You may pay via Venmo @amber-lopez-mieres The prices are listed above.

You may also pay via cash or check and take advatage of the Teacher/Sibling 10% discount discount.

You may make 4 monthly payment each semester of $71.50/month. Contact Ms. Amber to make arrangements for monthly payments. Monthly payments must be completed before the club starts January 22, 2025.

Be sure to hit submit!