fff
|
|
|
|
|
TO PAY FOR SHOW TICKETS AT $15 EACH OR PAY BALANCES: You can pay for all TICKETS & Acting Programs by including the name of the child and the Amount and CLICK ON "BUY NOW" BELOW and put $____ amount or $15 FOR 1 SHOW TICKET OR $30 FOR 2... OR any other amount to pay via credit card or paypal and we will receive payment confirmation. THANK YOU FOR YOUR PAYMENT AND TO SUPPORT OUR THEATER!
_____________________________________________
OR TO REGISTER TO CAMP VIA EMAIL ONLY : COMPLETE THIS FORM TO REGISTER AND RETURN IT TO: Contact@rmctonline.com Holiday Show ____ Summer Camp ____ Workshops/Acting Classes: ____ STUDENT’S NAME #1: ________________________________________________________________ • AGE: _______ BIRTHDAY: _______/_______/____________ GRADE FALL : _______ STUDENT’S NAME #2: ________________________________________________________________ • AGE: _______ BIRTHDAY: _______/_______/____________ GRADE FALL: _______ PARENT/GUARDIAN NAMES: _________________________________________________________ _______________________________________________________________________________________ ADDRESS: ____________________________________________________________________________ _______________________________________________________________________________________ PHONE: _____________________________________ ______________________________________ EMAIL: ______________________________________________________________________________ EMERGENCY CONTACT NAME: _______________________________________________________ • PHONE: _____________________________________ PHYSICIAN: __________________________________________ PHONE: _______________________ HEALTH ISSUES: _____________________________________________________________________ _______________________________________________________________________________________ MEDICAL CONDITIONS: ______________________________________________________________ _______________________________________________________________________________________ DIETARY RESTRICTIONS: _____________________________________________________________ _______________________________________________________________________________________ List all medications your child is taking now: _________________________________________ _______________________________________________________________________________________ Child’s Health Insurance: ____________________________________________________________ • Policy Number: ______________________________________ MEDICAL RELEASE FORM In case of a medical emergency, we must have your written permission to seek im- mediate medical attention for your child. The information above in this release is correct and my child has permission to take part of all RMCT youth theater activities. In case of emergency, I give my consent to provide my child with emergency medical care needed and I agree to assume all re- sponsibility for charges incurred. LIABILITY RELEASE FORM I am the parent/guardian of a minor, on behalf of the minor, thereby fully release and discharge RMCT - Youth Actor Theater, its assigns, and successors, from all rights, claims, and actions which the minor or his/her successors may have against RMCT - Youth Actor Theater arising out of the minor’s participation. _______________________________________________________ Parent or Legal Guardian (SIGNATURE) _______/_______/____________ Date signed COVID-19 PUBLIC HEALTH-ACKNOWLEDGMENT AND DISCLOSURE I UNDERSTAND THAT DURING THIS COVID-19 PUBLIC HEALTH EMERGENCY, I WILL NEED TO RESPECT THE PROCEDURE IN PLACE FOR THE SAFETY OF ALL PERSONS PRESENT IN OUR FACILITY. I UNDERSTAND THAT TO PARTICIPATE IN ALL RMCT ACTIVITES, MY CHILD MUST BE FREE FROM COVID-19 SYMPTOMS. IF AT ANY TIME DURING MY CHILD’S ATTENDANCE ANY OF THE COVID SYMPTOMS APPEAR, MY CHILD WILL NEED TO RETURN HOME AS SOON AS POSSIBLE. _______________________________________________________ Parent or Legal Guardian (SIGNATURE)
_______/_______/____________ Date signed
====================================================================================== |
|
|||||||||||||||
