Acting 101/102 Registration Form

Acting 101/102 Registration Form
Name

First NameLast Name
Date of birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Preferred Audition Date & Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Previous Acting Experience (if any)
Special Skills
e.g., singing, dancing, stage combat
Any Additional Comments or Information
I, the undersigned, do not hold Creative Arts Council of Wells County (Creative Arts) or any of its staff or guest faculty responsible for any accident that may happen by nature of the physical, athletic activity engaged in while attending classes, rehearsals or performances at Creative Arts or off site. I hereby authorize the instructor/staff of Creative Arts to act for me in any emergency requiring medical attention, if the above responsible adult(s) cannot be reached. I understand that all participating students are required to have their own accident insurance coverage. I understand, further, that photographs and recordings of students are sometimes used by Creative Arts for promotional purposes. These may include: website, social media, newspaper, television, etc. By signing this agreement, I give the Creative Arts Council permission to use my contact information for these purposes. I understand I am able to opt out of receiving both emails and text messages at any time. I agree to pay tuition in full at the time of this registration or to pay the Creative Arts office by phone or in person in order for my spot to be held. I understand tuition is non-refundable.
Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty: