Fall & Spring Classes
2008 - 2009
Sale # ______________
Lake Worth Playhouse Class Registration Form*
Please complete this form in its entirety, using one form per student.
*Print all info clearly, and mail, fax or bring the completed form to:
Lake Worth Playhouse, 713 Lake Avenue, Lake Worth, FL 33460
www.lakeworthplayhouse.org
*Fax your completed registration, with your Visa or Mastercard info to:
561-586-8832
NO REFUNDS AFTER 1st CLASS (5% cancellation fee on all refunds)
Classes will be canceled for religious and national holidays, and will follow the public school schedule.
Please call 561-586-6410 with any questions.
Name: ________________________________________________________________M/F ______
Age: _____Birth Date: ____/____/____ Grade (Winter 08): _____ School: __________________
Parent/Guardian Name: ___________________________________________________________
Address: _________________________________City: ___________________ Zip: ___________
E-Mail: _______________________________
Home Phone: _________________________ Emergency Phone: _________________________
Receive a 10% Discount
if you register for
Spring and Fall Classes
at the same time!
FALL CLASSES
___ Musical Theatre I (Ages 9-12) Aug 27 - Nov 12 - Wednesdays - 5:30 - 7:00 Tuition: $225
___ Musical Theatre II (Ages 11-17) Aug 28 -Nov 20 - Thursdays - 5:30-7:00 Tuition: $225
___ Creative Kids (Ages 5 -8) Aug 25 - Nov 17 - Mondays - 5:30 - 6:30 Tuition $225
___ Bak/Dreyfoos Audition Workshop Aug 26 - Dec 9 - Tuesdays - 5:30 - 7:00 Tuition $350
SPRING CLASSES
___ Musical Theatre I (Ages 9-12) Jan 14 - Apr 8 - Wednesdays - 5:30 - 7:00 Tuition: $225
___ Musical Theatre II (Ages 13 & Up) Jan 15 - Apr 9 - Thursdays - 5:30-7:00 Tuition: $225
___ Creative Kids (Ages 5 -8) Jan 12 - Apr 20 - Mondays - 5:30 - 6:30 Tuition $225
PRIVATE COACHING
___ Private Coaching (Ages 8-18) Times to be scheduled with teacher Tuition: $50/hour
___ Private Coaching (Adults) Times to be scheduled with teacher Tuition: $50/hour
PAYMENT OPTIONS:
___ Check # _______ (payable to Lake Worth Playhouse) Or ___ Cash enclosed for $ ________
Or Charge $ ___________ to my Credit Card. ___ Visa ___ Mastercard
CC # ___________________________________________Exp: ___________
Tuition - 50% deposit per class. Balance due in full by 1st Class
Balance Paid on ____/____/____ Check # ______or ___Visa ____Mastercard
Yes, I'd like to contribute to assist students in need of financial aid. Donation:______ Total: ______
MEDICAL INFORMATION
Please list any health or learning challenges, medications, physical limitations, allergies, etc.:
____________________________________________________________________________________________
LIABILITY WAIVER (for a minor)
I, __________________________________, the undersigned ____mother of ____father of ____ legal guardian of
____________________________________ a minor, on behalf of the minor, hereby fully release and discharge
the Lake Worth Playhouse, Inc., its assigns and successors, from all rights, claims and actions which the minor or his or her successor may have against the Lake Worth Playhouse, Inc., arising out of the minor's participation.
________________ _________________________________________
Date Signature of Parent/Guardian
I consent that any photograph in which the above named individual appears while participating in above named show may be used by the Lake Worth Playhouse, its assigns or successors, in whatever way they may desire. Furthermore, I consent that such photographs (and plates from which they are made) shall be the property of the Lake Worth Playhouse and they have the right to scan, duplicate, reproduce, and make other uses of such photographs and plates as they may desire, free and clear of any claim whatsoever on my part.
________________ _________________________________________
Date Signature of Parent/Guardian
Enrollment will be accepted in the order received. Date Rec'd: ________________