Applause Children's Theater: Let's Act! Summer Camp (Kids ages 5-9) (July 20-July 24, 9 am-12 pm)

Applause Children's Theater: Let's Act! Summer Camp (Kids ages 5-9) (July 20-July 24, 9 am-12 pm)

$175 for first child, $165 for each additional child
Child's Name

First NameLast Name
Child's Age
Child's Grade ('26-'27 school year)
Child's T-shirt Size
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MEDICAL TREATMENT PERMISSION & RELEASE: I give my permission to Applause Children's Theater/ACT its employees, agents, assigns, or contractors to secure needed medical or dental treatment for my child. I agree to assumefinancial responsibility for the cost of such treatment. (If I am not present or cannot be reached) The laws of the State of California shall apply to this Medical Treatment Permission & Release. If any of the provisions, terms, clauses, or waivers or releases of claims or rights contained herein are declared illegal, all other provisions, terms, clauses and waivers and releases of claims and rights contained herein shall remain valid and binding.
INITIALS HERE
LIABILITY: I understand that there are hazards and risks, as well as benefits, associated with my child's participation in educational, recreational, and/or performance activities APPLAUSE classes and productions; including but not limited to the risk of theft, damage to personal property, and/or personal injury. I, on behalf of myself, my child, my or their heirs, executors, administrators, agents, assigns, and other personal representatives, irrevocably and unconditionally remise, release, settle, compromise and forever discharge any and all manner of suits, actions, causes of action, damages and claims, that I or my child, have or may have against ACT.
INITIALS HERE
IMAGE/NAME PERMISSION & RELEASE: Occasionally, ACT staff members wish to photograph, videotape, or otherwise record the activities of our theatre school students for publicity uses or for our archives. I give permission for my child as a participant in the program to be videotaped, photographed or otherwise have his or her image and voice recorded, in connection with the Program. I give permission for ACT to use said videotape, photograph, name and/or recorded materials. I hereby waive and release any rights that I may have to said videotaped, photographed, and/or recorded.
INITIALS HERE
REFUND POLICY: I understand that after my child attends their first class session, no refunds will be issued for any reason.
INITIALS HERE
INDIVIDUALS ALLOWED TO PICK UP:(I.D. MUST BE SHOWN) Please list name, phone, relation
ACCEPTED AND AGREED BY:

First NameLast Name
Please list any medical conditions/allergies your child/children has or medications they are currently taking:
In case of emergency please contact:

First NameLast Name
Emergency Contact Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Additional Child's Name

First NameLast Name
Additional Child's Age
Additional Child's Grade ('26-'27 school year)
Additional Child's T-shirt Size
Additional Child's Name

First NameLast Name
Additional Child's Age
Additional Child's Grade ('26-'27 school year)
Additional Child's T-shirt Size

Payment Amount

USDfirst child $175, $165 for every additional child

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty: