After School Form

Child's Full Name*

First

Last

Age*

Child's School*

Grade Level*

Parent / Guardian's Full Name

First

Last

Cell Phone*

Work Phone*

Address*

City*

State*

Zip Code*

Email Address*

Theater

Tuition Listed As

Listed Class Time

Listed Start Date

Karate

Tuition Listed As

Listed Class Time

Listed Start Date

Debate

Tuition Listed As

Listed Class Time

Listed Start Date

Guitar

Tuition Listed As

Listed Class Time

Listed Start Date

K. Acting

Tuition Listed As

Listed Class Time

Listed Start Date

Singers

Tuition Listed As

Listed Class Time

Listed Start Date

Dance

Tuition Listed As

Listed Class Time

Listed Start Date

LOL...Comedy

Tuition Listed As

Listed Class Time

Listed Start Date

Holiday Theater

Tuition Listed As

Listed Class Time

Listed Start Date

$10 Admin & After School Insurance Will Be Added To Your Total

Policies & Information*

Yes

- Parent responsible for class start date and attendance.
- Parent may call for class confirmation. Confirmations are NOT sent.
- Parent must pick up student promptly after class.
- NO CLASSES on pupil free days or holidays.
- Space is limited. $15 processing fee for all refunds.
- To drop a class, call BEFORE the second class meeting.
- Refunds are NOT permitted after the 2nd week has passed.
- There are no credits or refunds when children miss class.
- A limited number of full scholarships are available.
- All instructors are trained and cleared before placement.
- I allow my child to participate in any promotional pictures from the class.
- By submitting this form it is understood that I have read and agree to the information regarding dates, rules, refund and company policies. On behalf of my child and myself, I knowingly assume all risks arising from participating in class activities. I certify that I have legal authority to sign this release/waiver of liability, and sign it without duress or coercion.

Does your child have permission to be released to walk/bike home after every class:*

Yes

No

IF YES, DOWNLOAD THE AUTHORIZATION FORM & SEND THE FORM BACK TO PERFORMINGARTSLA@AOL.COM BEFORE CLASSES BEGIN! WALK/BIKE AUTHORIZATION FORM

On-site Day Care: *

IS enrolled in the On-site Day Care: If your child attends on-site day care at school, our teacher will walk your child to the daycare room after our class.

NOT enrolled in the On-site Day Care: I Acknowledge - If my child does not walk, bike, or attend on-site daycare she/he must be picked up within the 5 minute grace period following the completion of class.

Billing Information

Card Holder’s Full Name (as it appears on card)*

Card Holder's Phone*

Address On Card*

City*

State*

Zip*

Debit/Credit Card Info

Type of Credit Card*

Card Number*

Exp. Date*

CV2# (security code)*

Optional Camp T-Shirt

$10 Admin & After School Insurance Will Be Added To Your Total

Billing Information