2015 Henegar Summer Theatre Workshop Disney’s Peter Pan, Jr. Middle School: Grades 6-9 June 15-July 10 Cost: $300 Rehearsals: Mon-Fri 9am-12pm Performances: July 9 @ 1pm (Daycare Show), July 10 @ 7pm, July 11 @ 2pm and 7pm Student Name _________________________________________________________________ Age ______ Current Grade ______ School _________________________________________ T-Shirt Size: (CHILD) S M L (ADULT) S M L XL Address ______________________________________________________________________ City ______________________________________ Zip Code _______________ Phone (cell) __________________________ Phone (home) ____________________________ Email ________________________________________________________________________ Parent/Guardian Name(s) _______________________________________________________ Emergency Contact __________________________________ Phone ____________________ Method of Payment _____Cash _____Check ________ VISA/MC/DISC__________________________________________Exp_______CVV______ My child/ward _________________________ may be released to the following individual(s): Name ____________________________ Relationship to Student ____________ Initial _____ Name ____________________________ Relationship to Student ____________ Initial _____ By signing this, I understand that my child/war will be released only to his/her parent(s) or to the individuals listed above. These individuals MUST provide a legal picture ID when picking up my child/ward. Print Name ______________________________________________ Date_________________ Signature _______________________________________________