Dance Classes Registration

Drama Class Registration Form

Curtain Call Academy Inc. (CCA)
Child's Name*

First Name (name used in class)Last Name
Date of birth*

MonthDayYear
Date
Gender*

MaleFemale
School*

SoutheastSoutheast Homeschool Partnership (Wednesdays)Southeast Homeschool Partnership (Thursdays)Independent HomeschoolOther School
Grade*
Mom's Name *

First NameLast Name
Mom's Cell Number*
Please enter a valid phone number.
Mom's Email*
example@example.com
Dad's Name *

First NameLast Name
Dad's Cell Number*
Please enter a valid phone number.
Dad's Email
example@example.com
Child's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name (other than parent)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Medical Conditions or Allergies or Special Learning Needs
Class Selection*

Kindergarten -2nd grade: Wednesdays, 3:20-4:30 p.m. $58.00Grades 3-5: Tuesdays, 3:20-5:00 p.m. $68.00Grades 6-8: Tuesdays, 3:30-5:00 p.m. $68.00Private Coaching (by appointment) Current CCA Student: No Charge.Private Coaching (by appointment) Former CCA Student: $35.00 per hour.Private Coaching (by appointment) Non-CCA Student: $75.00 per hour.
Show Fee (due before January 31)

1 Child: $35.00Family (2 or more children) $60.00
How did you hear about us?

Word of MouthWebsiteSocial MediaFlyerSaw a Curtain Call Performance
Terms and Conditions:

By submitting this form, I acknowledge that participation in drama classes involves physical activity and I hereby release and hold harmless Curtain Call Academy Inc and its owners, instructors, and volunteers from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, illness, or injury, including death, that may be sustained by the participant and/or undersigned, while in or upon any premises under the use or control and supervision of Curtain Call Academy Inc, it's owners, instructors, and volunteers or in route to or from any of said premises, for injuries or accidents that may occur during classes or events.

Tuition is due on the first class meeting day of each month, for that month. Cash, Check or VENMO accepted. VENMO: Shelly-Terry-4 (verification number: 0726)

I hereby consent to the use of any photographs/video tape taken of my child by Curtain Call Academy Inc or the media for the purpose of advertising or publicizing events, activities, and programs in newspapers, newsletters, website, other publications, telivision, radio and other communications and advertising media. Duplication of, or posting of video on social media of any Curtain Call Academy Inc productions is strictly prohibited.

By submitting this form, I acknowledge and agree to the terms and conditions listed above.
Date Approved and Submitted

MonthDayYear
Date
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Drama Class Registration Form