Registration: Grades 8-12

Winter Classes

Student Registration Grades 9-12

Student Information

Please enter your student's first and last name: (required)

Preferred Name (for Name Tag):

Student's Age: (required)

Student's Grade: (required)

Birthdate: (required)

Gender: (required) MaleFemale

Are you a NEW or RETURNING student to ACT: (required)

Returning Students: Have you lost your binder? (required)

Does this student have a disability, special needs or allergies? (required)
YesNo

If YES, please describe this student's disability or special need. (ADD, ADHD, Asperger's, Sensory Issues, Developmental Delay, Epilepsy, etc) We can best help your child succeed if we know his/her background.

Selections Grades 9-12

Foundations of Acting

Foundations of Musical Theatre

Acting

Musical Theatre

Acting Outside the Lines (Improv)

Broadway Combo (Acting & Dance)

Acting & Stage Combat

Vocals with Dance for Performing Arts

Multi-Class and Sibling Discounts

Parental Information

Parent's Name: (required)

Street Address: (required)

City & State: (required)

Zip: (required)

Email Address: (required)

Best Phone (XXX-XXX-XXXX): (required)

Alternate Phone (Do NOT list the same number again): (required)

Medical Release

I hereby release the ACT, its agents and employees from any and all claims and liabilities resulting from participation with ACT-sponsored activities. In the event of an emergency, I understand that a reasonable effort will be made to contact me. If I cannot be reached, I hereby authorize an agent of the Academy of Children’s Theatre (ACT) to act on my behalf to seek emergency medical treatment for my child, listed above, in the event that such treatment is deemed necessary by that agent. I authorize the physician selected by said agent to administer such emergency treatment as said physician deems necessary (in his/her judgment) under the circumstances. I understand and agree that I will be responsible for payment of said physician's fee and any and all other fees or expenses associated with such treatment.

Parental Consent

Parent/Guardian Signature - by filling your name, you confirm that you agree to the medical release and have the legal right to sign for medical treatment of the afore mentioned minors. (required)

Signature

Date: (required)

Publicity Waiver

Unless informed otherwise in writing, the Academy of Children's Theatre (ACT) considers photographs and recordings (film, video, digital, etc.) taken of students and their work in class and in performance to be permissible for publication in ACT marketing materials and in informational publications, including our website.

Refund Policy (required)

I understand the the deposit is non-refundable.

Note to ACT

How did you hear about ACT?

Referred by: