|
The Neighborhood
Playhouse 732-548-3656 please attach any
photo here REGISTRATION AND PERMISSION FORM Fall and Spring,
2008-2009 Name:__________________________________________ Grade: _________ Parent or Guardian
Name(s): ____________________________________________ Complete mailing address:
______________________________________________ City, State, Zip:
_______________________________________________________ Date of Birth (month, date
AND year): _________________ I plan to use the
child-sitting service yes no Parent E-Mail Address:
_______________________________@___________ Student E-Mail Address: ______________________________@___________ Home Phone Number:
____________________________________ Parent Cell Phone(s):
____________________________________ Student Cell Phone:
_____________________________________ Emergency Contact Name and
Phone Number: ____________________________________ What school does your
child attend? ____________________________________________ Names and ages of
siblings: ___________________________________________________ Medical
Conditions/Allergies:
__________________________________________________ Please list any
medications your child is taking and the condition for which the medication is
prescribed
________________________________________________________________ _____________________________________________________________________ An Epi-Pen
is a life-saving injection for people with severe allergies. Does your child carry an Epi-Pen? Yes
No The We can not guarantee an allergen-free environment,
but we will remind students not to bring foods that are common
allergens. TUITION Grades 1
3 tuition
$
295 Grades 4
12 tuition
$
325 Intensive
(invitation only)
$
465 Yoga
(optional, Scene
study (optional, DONATION:
Thank you! $__________ENCLOSED Late fee
for forms received after July 15
$30 TOTAL: $_________________ If you
paid a deposit, subtract here: -$_________________ TOTAL ENCLOSED: $_________________ PAYMENT PLAN REQUEST: If
necessary, you may pay in installments.
Please tell me how much you can pay and when I should
expect payment. In order to ensure
sufficient enrollment for each class, full payment for the semester is expected no later than October 1. This
amount is enclosed. $_______________ I can pay
$________by this date _____________ I can pay
$________by this date ______________ I can pay
$________by this date _____________ Total:
$_____________ PHOTO/VIDEO RELEASE: The
Neighborhood Playhouse may take and use images
and/or videos of my child for advertising or display in media such as brochures, newspapers
and on Ψ
Parent Signature:
______________________________________________________ PERMISSION SLIP: I give
permission for my child, who is in
grades 9 12, to go out for lunch with classmates and to leave after class unaccompanied.
Ψ
Parent Signature: ____________________________________________________ I give
permission for my child, who is in
grades 1 8, to leave unaccompanied.
ONLY FOR PARENTS WHO ARE COMFORTABLE ALLOWING THEIR CHILDREN TO TRAVEL
ALONE! Ψ
Parent Signature:
______________________________________________________ HANDBOOK: I have read and understand the handbook and all rules and
regulations. I can find a copy of the
handbook at www.playhousejuniors.com
and in my childs backpack. Ψ
Parent Signature:
_____________________________________________________ DIRECTORY: I give
permission to the Neighborhood Playhouse to put my name, address and phone
number in the student directory. Ψ
Parent Signature:
_____________________________________________________ STUDENT INFORMATION: Any
singing roles or experience?
__________________________________________________ ______________________________________________________________________________ Any dance
roles or experience?
____________________________________________________ ______________________________________________________________________________ Any acting
roles or experience?
____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Does your child have any
learning differences (i.e. ADD, ADHD, Dyslexia)? If so, please explain.
Having this information helps us work with your child more
efficiently.
_______________________________________________________________________ _______________________________________________________________________ Is there anything else
that would help us understand your child better?________________
________________________________________________________________________ _______________________________________________________________________________ ________________________________________________________________________ What do you and your child
want to gain from our program?
_______________________ ________________________________________________________________________ ________________________________________________________________________ ·
Please attach a picture of the student. Picture may be a non-professional
photograph. ·
The Neighborhood Playhouse reserves the right to change the
schedule to accommodate paid enrollment. |