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 11-17)   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

 

Enrollment will be accepted in the order received.                     Date Rec'd: ________________