Student Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

(###)

###

####

Cell Phone *

(###)

###

####

Work Phone *

(###)

###

####

Emergency Contact Phone *

(###)

###

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Are there any allergies, medical conditions, or disabilities we need to be aware of? *

Yes

No

Parental Authorization *

I hereby waive and release any and all claims for damages, injuries or death that may be suffered before, during or after activities with RCT. I will further hold harmeless Riverside Children's Theatre and Riverside Theatre. I hereby authorize any physician, trainer, or nurse selected by RCT personnel to order and contact any emergency medical or surgical procedures necessary to safe life and limb. I understand and give permission for my child to be filmed for TV or photographed. I acknowledge that my child will abide by RCT's posted rules and regulations.

I have read and understand the parental authorization.

REFUND POLICY *

Refund Policy: Tuition is refundable up to five days before the first day of each class. Exceptions may be granted, upon written request.

I have read and understand the refund policy.

Class Adjustment Policy *

I understand that Riverside Theatre Educational Instructors reserve the right to move students who enroll in inappropriate classes for their age and/or experience level.

I have read and understand the class adjustment policy.