Winter Break Registration Form

Please complete the registration form below to ensure your spot in our programs. If registering more than one student, you must complete the form for each student.

Your registration is not complete until both the form response and class tuition are received.

Payment plans are available on request. Email sblain@broadwayboundkids.org for more informantion.

For more info, FAQs, and class descriptions, please visit InterActive BBK Winter Break Program

Billing Email*

example@example.com

Guardian #1 Name*

First NameLast Name

Guardian #1 Alternate Email

example@example.com

Guardian #1 Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Guardian #2 Name*

First NameLast Name

Guardian #2 Email*

example@example.com

Guardian #2 Phone Number*

Please enter a valid phone number.

Student Name*

First NameLast Name

Nickname

Birthday*

Grade*

Pronouns*

Which of the following best describes your student? Please select all that apply.*

Preferred Language*

Please share any information about your child's medical information, allergies, or access needs that you would like us to know. In addition, if you want to share any information about your child's physician, please include it here.*

Emergency Contact: Name/Phone Number*

Please initial below to authorize your student to self dismiss.

Apart from Guardian #1 & #2, please list who is authorized to pick up your child. Name/Phone/Relationship*

My Products*

Winter Break InterActive, Program Only ($699 + 4% cc fee)

$727.00 Quantity

Winter Break InterActive, Program and 2 Show Tickets ($899 + 4% cc fee)

$935.00 Quantity

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

**Please note, a 4% processing fee on your total will be added to your invoice**

How did you hear about Broadway Bound Kids?*

Please Confirm*

I agree

Assumption of Risk and Waiver of Liability Related to Coronavirus/COVID-19
Attending in-person classes, programs, or activities conducted by or in association with Broadway Bound Kids Inc. could increase your risk and your child(ren)’s risk of contracting COVID-19. Broadway Bound Kids has put in place preventative measures to reduce the spread of COVID-19 and seeks to follow the guidance and recommendations of government health agencies such as the Centers for Disease Control and Prevention and New York state and local government authorities. However, Broadway Bound Kids cannot guarantee that you or your child(ren) will not be exposed to or become infected with COVID-19 as a result of participating in our activities. Please read this agreement carefully as your electronic signature indicates that you have agreed to assume certain risks and to give up certain rights.

ASSUMPTION OF RISK By signing this agreement, I acknowledge that:

I have read the warning above concerning COVID-19 and understand there is a risk that I or my child(ren) may be exposed to or become infected with COVID-19 as a result of participating in Broadway Bound Kids’ classes and activities.
I understand such exposure or infection may result in personal injury, illness, permanent disability, or even death.
I understand that such exposure or infection could occur as a result of the actions, omissions, or negligence of myself, my children, or Broadway Bound Kids, its owners, directors, employees, agents, representatives, and volunteers.
I am voluntarily assuming this risk for myself and my child(ren) as part of participating in Broadway Bound Kids’ classes and activities.
I value my child(ren) being able to participate in Broadway Bound Kids’ classes and activities and am signing this agreement in exchange for such participation.

Indicate your understanding and acceptance of the above statement by initialing below: *

Please confirm your agreement to the Photo and Video Release statement*

I agreeI agree with limitations

Please clarify limitations.

Please confirm your agreement to the Other Matters statement **

I agree

I, Guardian Parent Name:*

First NameLast Name

certify that I am the legal guardian of the child listed below. Child's Full Name:*

First NameLast Name

I further acknowledge and agree to the statements above. **

I agree

Winter Break &Juliet InterACTive Registration Form

Participant Information

Select Your Programs

Liability Waiver

Please place your initials in each of the boxes below.

Agreement Not to Sue AND Waiver OF Liability

Photograph and Video Release

Other Matters

Confirmation

Winter Break &Juliet InterACTive Registration Form

Participant Information

Select Your Programs

​Liability Waiver

Please place your initials in each of the boxes below.

Agreement Not to Sue AND Waiver OF Liability

Photograph and Video Release

Other Matters

Confirmation

Liability Waiver