100 Acre Wood Registration

Select the theatre course you wish to register for:

Student's Name

Student's Age

Address: Street

Address: City

Address: State

Address: Zip

Parent/Guardian Name(s)

If over 18, please write "None"

Parent/Guardian E-mail Address

If over 18, please provide your own E-mail Address.

Parent/Guardian Phone

If over 18, please provide your own phone number.

Allergies

If you do not have allergies, please write "None"

Does the student carry an epipen?Yes
No

Emergency Contact Name(s)

Emergency Contact's Relationship To Student

Emergency Contact's Phone

Other than yourself.

Authorized Pick Up Options

If over 18, please write "None"

I accept that the Stadium may take photos of my child, which may be published online, or in print.I Accept

How did you hear about this course?

What school does the student attend?

If not in school, please write "None"

Please read the release below and check the box if you agreeIn consideration of my child/myself being permitted to participate in the program, I hereby release, waive, and discharge the Stadium Theatre, its directors, employees, and volunteers (collectively the "Stadium Theatre") from liability from any and all claims arising from negligence of the Stadium Theatre. I further agree to hold harmless, defend, and indemnify the Stadium Theatre against any and all claims arising from my child's/my own injury or loss due to my child's/my participation in the program, including the inherent risks of the program activities and those arising from negligence of the Stadium Theatre. I authorize the Stadium Theatre to arrange for medical treatment for my child/me in the case of an emergency. I accept that the Stadium Theatre may take photos of my child/myself, which may be published online, or in print.