EYT Summer Workshop Registration Form by ashrafp


									                EYT Summer Workshop Registration Form:
             Mail to The Empress Theatre, PO BOX 208, Magna, UT 84044 by June 17th, 2011

Students will learn and perform Willy Wonka. In addition, students will participate in workshops focusing
                          on specific acting, dance, vocal, and performance skills.

                 Students will audition for lead roles during the first week of workshops.

        Session Days: (Circle any conflicts)                  Performance Days: (No conflicts allowed)
  (up to three allowable conflicts before July 21 st)
          -------------July-------------                           ---------July/August---------
          M          T         W         Th                        M                 F          S
                     5         6         7                                           29         30
          11         12        13        14                        1                 5          6
          18         19        20        21                        8                 12         13
          25         26        27        28                        15                19         20

         _______ FULL DAY: $100 (Grades 7 – 12): 15 session days from 9:00 am to 4:30 pm
         _______ HALF DAY: $75 (Grades 3 – 6): 15 session days from 9:00 am to 12:30 pm

Contact Information:
Name: __________________________________________________ Grade (Fall 2011): ____________
Address: _____________________________________________________________________________
City: _________________________ State: _____ Zip: ____________ Main Phone: ________________
Parent’s Mobile: __________________ Parent’s Email: _______________________________________
Student’s Mobile: _________________ Student’s Email: ______________________________________
Allergies or Medical Conditions: __________________________________________________________

Please be prompt in dropping off and picking up your student(s). The Empress Theatre does not assume
responsibility for any child dropped off unattended. Please do not drop off your child(ren) more than 10
minutes before the class begins. Please contact us via text or voicemail at (801) 641-3898 to alert us if you
will be delayed in picking up your child due to an emergency, such as car trouble.

If fewer than the minimum number enroll, the class will be canceled. You will be notified and will receive
a refund. Parents must make refund requests and withdrawl from classes. NO REFUNDS WILL BE
AUTHORIZED AFTER THE FIRST DAY OF CLASSES. No refunds will be authorized in the event of a

I have read and will abide by the above policies. I am aware of the nature and content of the program and
assume the risks associated with my child’s participation. I agree not to allege or attempt to impose any
liability on The Empress Theatre in the event of any damage, injury or loss resulting from such

(Parent Signature)


______Credit Card (Visa/Mastercard/Discover)

Card Number____________________________________________________ Expiration Date___________________

Name on Card___________________________________________________ 3 digit security code off back ______________
                          ADDITIONAL INFORMATION:

Acting Experience:
Show: _______________ Character: _______________ Theater: _________________
Show: _______________ Character: _______________ Theater: _________________
Show: _______________ Character: _______________ Theater: _________________
Show: _______________ Character: _______________ Theater: _________________
Show: _______________ Character: _______________ Theater: _________________
_____ School drama classes/club      _____ Other drama classes/club

Vocal Experience:
Vocal Range:    Soprano        Mezzo Soprano    Alto    Tenor   Baritone     Bass
_____ School choir     ______ Church choir      ______ Other choir (_______________)
_____ Voice lessons (______ years)

Dance Experience:
Dance Styles:   Jazz     Tap     Ballet   Hip Hop      Modern   Tumbling      Ballroom
_____ School dance team(s)       ______ Private dance team(s)
_____ Dance lessons (______ years)

Additional Experience:
Musical Instrument:    ______________________________________ (______ years)
Martial Arts: ______________________________________________ (______ years)
Other: ___________________________________________________                 (______ years)

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