Live Arts Education Class Registration Form Winter 2020

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Please fill out this form to complete your registration for Winter 2020 classes. Your registration is not complete until you have filled out this form and paid for the class.

Email *

Name of student *

Age of student *

What school does the student attend (if applicable)? *

Grade level (if applicable) *

Please indicate what class you are registering for *

Check all that apply!

TREASURE TRUNK THEATER with Edwina Herring (AGES 4-6)

KIDS ON STAGE with Claire Chandler (AGES 7-10)

FRACTURED FAIRY TALES ON STAGE with Claire Chandler (AGES 7-10)

ACTING I: SCENE STUDY with Jennifer Tidwell (AGES 11-14)

ACTING I: NON-WESTERN APPROACHES TO SCENE STUDY with Ti Ames (AGES 15-18)

BEGINNING TAP with Stephanie Hess (AGES 14+)

INTERMEDIATE TAP with Stephanie Hess (AGES 14+)

ALEXANDER TECHNIQUE with Jennifer Tweel Kelly (Ages 18+)

(Brief) Introduction to the Meisner Technique with Carolyn McCandlish (Ages 18+)

Required

Name of Parent or Guardian (if applicable) *

Relationship to child (if applicable) *

Home # *

Work #

Cell # *

Email *

Second Parent/Guardian Email or Alternate Contact Email

Emergency Authorization and Consent for Live Arts Education Classes *

I, or I/We undersigned parents or legal guardians of the minor registered, do hereby give authorization and consent for medical treatment in the event myself, or my child, becomes ill or injured during a Live Arts class. Live Arts Staff or volunteers are authorized to take one or more of the following actions: a) provide reasonable basic first aid; b) release me or my child to the person listed below; c) take me or my child to a physician, or, d) take me my child to the hospital and/or give consent for emergency care.

I have read the above statement and agree

Person in addition to parent or guardian or self to contact in emergency (and relationship to minor or self) *

Home # *

Cell # *

Do you or your child have any special needs, (behavioral, medical, emotional, etc.), we should be aware of to help you or your child have a safe and positive class experience?

Yes

Clear selection

*If you answered YES to the above question* (if you answered no to the above question, skip ahead) Education Director Miller Susen will contact you prior to your or your child's first class to discuss how we can best help you or your child to have a good experience at Live Arts. Please indicate below that you understand and agree to be contacted.

Yes, I understand and agree to be contacted.

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What would you, or your child, most like to get out of the Live Arts Education experience?

How did you hear about Live Arts classes?

PLEASE NOTE: Your place in class is not reserved without payment. Please make sure to pay for the class online at our website.

If you would like to arrange an alternative to paying online, please contact Miller Susen directly at miller@livearts.org.

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