Please enter your student's first and last name: (required)
Preferred Name (for Name Tag):
Student's Age: (required)
Student's Grade-2020 Fall: (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.
Acting: Surviving Gilly's Island Camp SelectionSession 32 (July 13-17)
Acting and Stage Combat Camp SelectionSession 41 (July 27-31)
Acting Outside the Lines: Improv Camp SelectionSession 14 (June 15-19)
Dance for Musical Theatre: Grease Camp SelectionSession 19 (June 22-26)
Musical Theatre: The Music Man Camp SelectionSession 22 (June 29-July 3)
Shakespeare Camp SelectionSession 27 (July 6-10)
Vocals for Performing Arts: Wicked Camp SelectionSession 4 (June 1-5)
DiscountWe qualify for a sibling or multi-camp discount and would like to pay in full. Send updated invoice for balance due.We qualify for a sibling or multi-camp discount. We'll pay the deposit today and will be paying the balance by May 1st.
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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.
Signature (required)
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.
Cancellation by May 1st, tuition refunded minus $150 non-refundable deposit. Cancellation after May 1st, no refund.
I understand and accept the refund policy.
How did you hear about ACT?Please select oneThe Best of the Springs AwardsThe Gazette - Parent's GuideCS Kids MagazineHigh Country NewsletterKBIQ 102.7 FMKGFT 100.7 FMInternet SearchVehicle Window DecalFriendPrevious ACT ClassOther
