Apollinaire Play Lab
Class Registration Form
Student's Name:
First Name
Last Name
Class/es:
Creative Movement, Ages 3-5, Fridays 4:30-5:15, $125
Creative Movement, Ages 3-5, Saturdays 9:30-10:15, $125
Ballet and Jazz, Ages 6-9, Fridays 5:30-6:30, $145
Ballet and Jazz, Ages 6-9, Saturdays 11:30-12:30, $145
Hip Hop and Jazz, Ages 9-14, Saturdays 10:30-11:30, $145
Art, Ages 6-8, Saturdays 1:00-2:00, $135
Art, Ages 9-14, Saturdays 2:00-3:00, $135
Acting 1, Ages 6-9, Saturdays 10:30-11:30, $145
Play Production, Ages 10-16, Fridays 5:50-7 & Saturdays 11:30-1, $395
Address
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
Alternate Phone Number
Email
Additional/Alternate Email
Date of Birth
Age
Grade
Primary Language
Secondary Language
Parent or Guardian's Names/s:
Payment
Will you be
Paying Full Price
Using the EBT Culture Card Scholarship Program (classes are $40 each for the full session)
Applying for Scholarship or Payment Plan (no EBT card)
Back
Next
Save
Apollinaire Play Lab
Payment
prev
next
( X )
Play Production, Ages 10-16, Fridays 5:50-7 & Saturdays 11:30-1
$
395.00
Hip Hop and Jazz, Ages 9-14, Saturdays 10:30-11:30
$
145.00
Art, Ages 9-14, Saturdays 2:00-3:00
$
135.00
Acting 1, Ages 6-9, Saturdays 10:30-11:30
$
145.00
Art, Ages 6-8, Saturdays 1:00-2:00
$
135.00
Ballet and Jazz, Ages 6-9, Fridays 5:30-6:30
$
145.00
Ballet and Jazz, Ages 6-9, Saturdays 11:30-12:30
$
145.00
Creative Movement, Ages 3-5, Fridays 4:30-5:15
$
125.00
Creative Movement, Ages 3-5, Saturdays 9:30-10:15
$
125.00
EBT Card for Culture (please select the number of classes)
$
40.00
Quantity
0
1
2
3
test
$
0.01
Total
$
0.00
Credit Card
Back
Next
Save
Scholarship Application
For families requesting scholarship without an EBT card.
Student's Name:
First Name
Last Name
Amount your family can contribute towards tuition:
Would you like to consider a payment plan?
Please give a brief description of the family's financial situation:
Anything else we should know:
Back
Next
Save
Program Expectations & Release Form
Apollinaire Play Lab classes are designed for motivated student actors and artists. Participants who are not able to focus their energy on the work of the class and contribute to the progress of the group will be asked to leave the program.
Students are expected to attend all classes.
Please call or email when your child will miss a class due to illness. We reserve the right to dismiss any student due to multiple absences or repeated tardiness.
Students must be dropped off and picked up before and after class. Students may not wait unattended while other classes are in session.
Photo Release:
Occasionally, we take photographs of students during classes and performances at Apollinaire Play Lab. We may use these images in print publications that we produce, as well as on our website, or on display boards at the studio. Images may also be used for newspaper advertisements or press releases. We will not use personal details of any person in a photographic image without prior specific permission not covered by this consent form. By submitting this form you consent to use of photographic images.
Illness:
If a child should become ill while attending the program, the parent or designated emergency contact will be notified immediately. It remains the responsibility of the parent to provide transportation for the child. Heading
Accident:
In case of accident I agree to hold TheatreZone, Inc. dba Apollinaire Theatre Company and Apollinaire Play Lab and its instructors blameless and to refrain from legal action.
I understand that if a participant is unable to participate for any reason, or is asked to leave the program due to unsatisfactory attendance (absent more than 2 sessions), tardiness, or disruptive conduct, the class fee will not be returned.
Further, I hold TheatreZone, Inc. dba Apollinaire Theatre Company and Apollinaire Play Lab and its employees in no way liable for any damage sustained to my child or his/her property while participating in the Apollinaire Play Lab Program.
By submitting this form, I accept the terms and conditions of enrollment for my child described above.
Save
Submit
Apollinaire Play Lab
Riseman Family Theatre • Chelsea Theatre Works, 187 Winnisimmet St. Chelsea, MA • apl@aplaylab.com • 617-615-6506 •
Should be Empty: