Stages Reg12 by 60JURu

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									             Theater Academy and Performance Company for Youth
     12-Week Spring Program Registration September 18 – December 9, 2012


                           PAYMENT AND CLASS INFORMATION

$100 class deposit may be made via our PayPal registration on www.arthouseproductions.org, or
mail check/money order along with this form to:

Art House Productions
1 McWilliams Place, 6th Floor
Jersey City, NJ 07302

The 12-week company program pricing is as follows:
$750 for total 12-week program

PAYMENT SCHEDULE
$100 deposit                                              Payment #1
$250 due by September 18 (first day of class)             Payment #2
$200 due by October 16                                    Payment #3
$200 due by November 13                                   Final Payment
We offer a 15% sibling discount

LATE PICKUP POLICY
Students must be picked up promptly at 5:30pm. We will bill $20 for every 10 minutes after
5:30pm you are late in picking up your child.

CHECK BOX                         ☐I understand and will comply with the late pickup policy.

MISSED CLASSES
Please note that we do not refund for missed classes. If your child has to miss a session due to
illness or family scheduling, they will be caught up with their instructors when they return.

CLASS TIMES AND LOCATION

Tuesdays and Thursdays 9/18 – 12/9: 4:00-5:30pm
NO REHEARSAL ON THE THURSDAY OF THANKSGIVING
Additional rehearsals for play: Sat 11/3, Sat 11/17, Sat 12/1 (time TBA in morning) with snack
break
Final rehearsals: Monday 12/3, Tuesday 12/4, Wednesday 12/5 (4pm-8pm) with dinner break
Performances: Thursday 12/6 at 7pm, Friday 12/7 at 7pm, Saturday 12/8 at 7pm, Sunday 12/9 at
2pm
Art House Productions
1 McWilliams Place, 6th Floor, Jersey City, NJ 07302
(SE Corner of Hamilton Park, near Erie / 8th St)
A limited number of scholarships are available. If you wish to apply for a STAGES! scholarship, please
contact Christine Goodman, Executive Director, at info@arthouseproductions.org for application.




                 Theater Academy and Performance Company for Youth

                                    STUDENT APPLICATION


Participant’s Full Name            ___________________________________


                                   ☐Male             ☐Female

Date of Birth                      ___________________________________

Age as of Sept 18, 2012            ___________________________________

Street Address                     ___________________________________

City/State                         ___________________________________

Zip                                ___________________________________


Parent Name                        ___________________________________

Cell #                             ___________________________________

Home #                             ___________________________________

Email Address                      ___________________________________


Emergency Contact Name             ___________________________________

Phone #                            ___________________________________


Other Authorized Adult(s) to pick up child

Name                               ___________________________________

Relation                           ___________________________________

-OR-                               ☐ My child will leave on his/her own
                                      MEDICAL INFORMATION


Is your child taking any medications we should know about? If so, please list:

___________________________________


List any sicknesses, allergies (including nut allergies) or diseases your child has currently:

___________________________________


List any medical conditions we should be aware of:

___________________________________



     GENERAL RELEASE AND WAIVER OF LIABILITY AND HOLD HARMLESS
                           AGREEMENT

General Release and Waiver of Liability and Hold Harmless Agreement
In consideration of being allowed to participate in any way in the STAGES! Fall 2011 program I, the
parents(s) and/or legal guardians(s) of the minor named below agree to assume all risk of any kind of injury
or damage my child may receive or sustain as a result of participation, including property loss, property
damage, personal injury or death.
By my signature below, I acknowledge my understanding of this release and hold harmless and agree and
confirm that:
1.        As the parent/guardian, it is my responsibility to instruct the minor participant if he or she believes
     anything is unsafe, the participant should immediately advise the STAGES! instructors of such
     condition and refuse to participate.
2.        The below-named minor may, during the course of the program, participate in the following
     activities: rhythm and dance, acting games, singing, improvisation exercises, live performance.
3.        I grant permission for the below-named minor to receive medical treatment for any and all injuries
     and illnesses sustained or experienced during his/her participation STAGES! activities, included but
     not limited to emergency first aid, emergency transport to a medical facility, and emergency treatment
     by medical personnel onsite or at a medical facility.
I KNOWINGLY AND FREELY ASSUME ALL RISKS, BOTH KNOWN AND UNKNOWN, AND
HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS, FOR MYSELF, THE BELOW NAMED
MINOR AND OUR HEIRS, ASSIGNS AND NEXT OF KIN, SILVERMAN PROPERTES, HAMILTON
SQAURE, ART HOUSE PRODUTIONS, INC. AND EACH OF THEIR TRUSTEES, OFFICERS
EMPLOYEES ,AND VOLUNTEERS, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY,
DEATH, or loss or damage to person or property associated with the presence or participation of the minor
in my charge, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR
OTHERWISE, to the fullest extent permitted by law.

Parent/Legal Guardian Signature:               ___________________________________

Parent/Legal Guardian (Print Name): ___________________________________

Child’s Name (Print Name):                     ___________________________________

Date:                                          ___________________________________
                Theater Academy and Performance Company for Youth


                                       PHOTO RELEASE

Photo Release for Children Under 18 Years of Age

I hereby grant to Art House Productions, Inc. and to its employees, and assigns the right to
photograph my dependent and use the photo and or other digital reproduction of him/her or other
reproduction of his/her physical likeness for publication processes, whether electronic, print,
digital or electronic publishing via the Internet.

I certify that I am a custodial parent and have the aforementioned rights to assign.

Parent/Legal Guardian Signature:          ___________________________________

Parent/Legal Guardian (Print Name): ___________________________________

Child’s Name (Print Name):                ___________________________________

Date:                                     ___________________________________




    PLEASE RETURN THIS COMPLETED FORM ALONG WITH DEPOSIT
             (IF NOT PAYING DEPOSIT VIA PAYPAL) TO:
                   ART HOUSE PRODUCTIONS, INC.
                  1 MCWILLIAMS PLACE, 6TH FLOOR
                       JERSEY CITY, NJ 07302

								
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