DFP use CD/L B E Located at The Orchard's Mall 1800 Pipestone Rd., Benton Harbor,MI V Performances: March 20,21,22,27,28,29,2015 Registration Form Student's Name (and/or nickname) Home Phone Number Street Address Male/Female City State Zip School Grade Age Date of Birth Parents Names email - Parent 2nd email - additional parent or student Mom's Work Place Mom's Work Phone Mom's Cell Phone Dad's Work Place Dad's Work Phone Dad's Cell Phone Emergency Contact Name (nearest Relative/Friend) Qty Emergency Contact Home Phone Group Grade Notes Troupers K - 12 $189 if payment received on or before 12/06/14. $269 after 12/06 Emergency Contact Mobile Fee Rehearsal CD: Mandatory with registration Actor's Script: Optional Required: Makeup kit (if you previously purchaseda makeup kit change amount in "Fee column" to $1 for new sponges) Optional: "Shrek Jr." T-shirt *Select Size Optional: Contribution to KOS Scholarship Fund *Shirts may be ordered later - deadline will be announced Kids On Stage Policies 1. Cancellation Policy: If you cancel your registration with less than a two weeks' notice before the class begins, no refund will be given. $50 of tuition is non-refundable. There will be no refund after Dec 31, 2014 Cancellation by KOS: We reserve the right to cancel a class if enrollment is insufficient. Any tuitionpaid will be refunded in full. Please do not send your child to class if he/she is not feeling well. Note: There is a 4% processing fee added to all payments made by credit/debit card. See bottom of page 2 for other payment options. Sub-Total Fees Scholarship applied requires prior approval Total Fees Amount Parents - Please Read and Sign the following Waiver By signing below, I agree to release and discharge Doug Fordyce Productions, LLC and its offiers, directors, employees, volunteers and agents of and from any claims, demands, or liability of damage arising from the participation of my student in any classes or programs sponsored by Doug Fordyce Productions, LLC. I also give permission to Doug Fordyce Productions, LLC, without limitation or obligation, to photograph or video my student in relation to their participation with Doug Fordyce Productions, LLC. Photographs or video may be used for archival or promotional purposes. I also agree that there will be no registration refunds after Dec 20, 2014 I also agree that by registering my student and signing below, they WILL attend the MANDATORY rehearsals and all performances in their entirety as listed on www.dougskidsonstage.com schedule information. PLEASE DO NOT REGISTER YOUR CHILD if they will fail to attend any one of these mandatory rehearsals without prior permission to miss. Typed name represents Parent/Guardian Signature Date Please list any scheduled vacations or other conflict dates the student will NOT attend rehearsal: for kids: We want to know about you and your theatre experience (It's ok if you don't have any experience, but feel free to brag) Name some plays you've been in, or roles you've had and the group or school you did it with: Any formal training in Dance? Gymnastics? Other? How much training (example 3 yrs. ballet, 2 yrs gymnastics): Name your singing experience and training (if you've had some): What are your interests and goals in theatre? Why do you want to attend KIDS ON STAGE? What are some of your hobbies, other than theatre? Name some of your favorite Singer/Songs, Website, etc. for parents: Where did you hear of KIDS ON STAGE? (Select from list or type in your answer) I put the parent orientation meeting,Jan 3 at 1:30pm on my calendar. Yes No but I will email or call you for an appointment Do you have a theatrical background? Care to elaborate? If you are interested in Volunteering during the production, check of any of the areas you are interested in - or type your suggestion here: Marketing Make Up Costumes Props Dresser Child Supervision Concession Usher Fundraisers Stage Crew Set Construction Tech Week Dinner Organizer Bake Cookies lClean-up/Janitorial help Cast Party Organizer Payment can be made in one of three ways: 1. Print this completed form and mail with check payable to DFP, PO Box 224, Stevensville, MI 49127 (no extra fees) 2. Fill out form, note the total fee, then go to www.dougskidsonstage.com/registrationonline.html and pay with your credit card. A 4% processing fee is added. 3. Call Doug 269-313-2795 with your credit card number. A 4% processing fee is added. Be sure to print and save a copy of this form for your records. Print Form