Youth Actor's Studio Winter/Spring 2021 Registration Form

Youth Actor's Studio: Grades 4-9 (ages 9 - 15)

10 weeks/70 minute sessions

Session A = Wednesdays 6:00 - 7:10pm or

Session B = Wednesdays 7:20 - 8:30pm

$250 includes all fees

Start date Wednesday January 6, 2021

Performance Saturday March 13, 2021

Students enrolled in this acting program will have an opportunity to perform multiple roles, act using improv skills, develop creative storytelling techniques, refine acting methods, and a chance to perform a play created by the cast and director based on a chosen theme. They will be directed under the instruction of Philip Kittiver, a well known area actor, director and playwright.
The workshop challenges performers of all experience levels.

Performer's Information

Performer's Name *

First Name Last Name

Nick Name (If applicable)

Birth Date *

Month Day Year

Grade

Age *

Gender

Male Female

T-shirt Size *

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Parent/Guardian Information #1

Name #1 *

First Name Last Name

E-mail #1 *

Cell Number #1 *

Area Code Phone Number

Home Number #1

Area Code Phone Number

Parent/Guardian Information #2

optional

Name #2

First Name Last Name

E-mail #2

example@example.com

Cell Number #2

Area Code Phone Number

Home Number #2

Area Code Phone Number

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is your child prescribed an inhaler? If yes, please explain any instructions.

Is there anything else you would like us to know about your child?

Informed Consent and Acknowledgement

I understand and agree that in participating in any classes, programs, workshops, camps, events, or activities there is a possibility of physical illness, bodily injury, disability, paralysis, or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Theater in the Park, LLC classes, programs, workshops, camps, events, or activities. I also exempt, release, and indemnify Theater in the Park, LLC, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Theater in the Park, LLC. I further hereby voluntarily agree to waive my rights and that of my heirs and assign to hold Theater in the Park, LLC its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them.
This portion of the agreement shall be in effect from this day forward.
My child and/or I have read, understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the said program. I am signing this form of my own free will and I am not under duress to sign this form.
Without limitation, or obligation, any and all media, including photographs, film footage, or tape recordings, which may include my or my child's image or voice for purposes of art, advertising, education, or promotion, or for any other purpose consistent with the Mission, and release from any claim or liability to that use. The images become the exclusive property. I waive all rights to inspect it/or approve any text that may be used in conjunction with the media and the use to which it may be applied.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature *

Clear

Workshop Requirements

Participants will do their best to miss no more than 2 rehearsal at most.

Participants will be responsible for their own contumes for the performance (if desired) unless Theater in the Park is able to provide items needed. Costume costs will not exceed $50.

Worshop Fee Includes

1. Show script

2. Professional Director and staff to student ratio for optimum learning

3. Program t-shirt

4. Sets, props, sounds and lights for final performances

5. Instruction each week of program with a performance for family and performance livestream for extended family and friends.

NOTE: All fees for this workshp are non-refundable. If a student is unable to attend the workshop and notice is given one month prior to start date, 75% of the workshop fee can be used toward future Theater in the Park workshops. After that date, the registration and tuition fee for the assigned workshop will be forfeited as the tuition fees are used to fund the staff, matarials and space as projected for the workshop. If "in person" classes have to be postponed due the to pandemic, classes and instruction will continue virtually and tuition will remain the same with no possibility of reimbursement.

Workshop Times (choose one)

Youth Actor's Studio - Session A (ages 9 - 15) 6:00 - 7:10pm $ 250.00

Youth Actor's Studio - Session B (ages 9 - 15) 7:20 - 8:30pm $ 250.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Youth Actor's Studio Registration