Class Registration Form

Class Title

Student Information

Name *

Phone Number *

Street Address *

City, State, Zip *

Student Email

Date of Birth *

Grade Level *

School *

Parent 1 Name *

Parent 1 Phone Number *

Parent 1 Email *

Parent 2 Name

Parent 2 Phone Number

Parent 2 Email

Emergency Contact *

Phone Number *

Relationship *

Medical Information

Allergies or Medical Conditions

Current Medications

Relevant Medical History

Drop Off and Pick Up Policy

Students can be dropped off 10 minutes before class begins and must be picked up by 10 minutes after the class ends.

Acknowledgement of Registration, Payment Policy, and Liability Waiver

I understand the drop off and pick up policy and that tuition is non-refundable. I further hereby release Outcry Theatre staff, board, teachers, and volunteers, from any and all injuries. I, my heirs, and representatives agree to indemnify, save and hold harmless Outcry Theatre from any and all claims made by me, my youth, any other family member, or my insurer, for any injuries, or damages related to this event. I agree that Outcry Theatre has the right to use photos or videos of my youth for publicity purposes without payment to me or my youth. *

Yes