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) Please select oneNew StudentReturning Student
Returning Students: Have you lost your binder? (required) Please select oneYes, I need to order a NEW binder for $5No, I do not need a new binderI am a NEW Student (Binder is Complimentary)
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.
Foundations of Acting Seminar Options
Foundations of Musical Theatre Seminar Options
Acting Acting Option
Musical Theatre Musical Theatre Options
Acting Outside the Lines (Improv) Acting Outside the Lines (Improv) Option
Broadway Combo (Acting & Dance) Broadway Combo Option
Acting & Stage Combat Acting & Stage Combat Option
Vocals with Dance for Performing Arts Vocals with Dance for Performing Arts OptionSession 10 (June 8-12) - 3 Openings
DiscountsWe qualify for a discount and would like to pay in full. Send updated invoice for balance due after deposits are paid today.We qualify for a discount. We'll pay the deposits today but will be paying monthly for the balance due.
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)
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.
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)
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.
I understand the the deposit is non-refundable.
How did you hear about ACT?Please select oneBest of the Springs AwardsBriargate Church Trunk or TreatThe Gazette - Parent's GuideCS Kids MagazineHigh Country NewsletterKBIQ 102.7 FMKGFT 100.7 FMInternet SearchVehicle Window DecalFriendPrevious ACT ClassOther
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