Ages 11-13 Registration

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This registration form is for ICE Collab's Classes, Shows, and Private Lesson Registrations.

Student First and Last Name *

Student Age *

Parent/Guardian First and Last Name *

Parent/Guardian Phone number *

Parent/Guardian Email *

Address (we use this to send thank you and holiday cards to our students)

What are you Registering for?

One hour Private Lesson

3- One hour Privates Lessons (to be completed in one month)

On going Private Lessons: 3 per month, 3 month minimum

On going Private Lessons: 4 per month, 3 month minimum

What's your favorite way to be creative? *

Singing

Dancing

Drawing

Building

Acting

Writing

Other:

Required

We will be using Zoom for our classes. Your student will need either a computer or a phone with a camera and microphone. *

Got it!

We have technology restrictions, and are unable to participate in a live class- but would still like the videos of classes.

Other:

All Payments can be made through Paypal. Link: Paypal.Me/icecollab *

$60/hr One Private Lesson

$150 for Three Private Lessons (to be used in one month)

I would like to apply for financial assistance

$135 for Three lessons per month: 3 month minimum

$180 for Four lessons per month: 3 month minimum

Required

Media Consent: By selecting the "Agree to Media Consent" you are as Legal Guardian or Parent of registering Student providing Imagine, Create, Explore Collaborative Arts permission to use my images (still or video) of my Student from images taken in class or during performances for all advertising and promotional materials, including, but not limited to, print, Facebook, Twitter, other social media platforms and the company website. Imagine, Create, Explore will not use last names but may use students first name, age, character names, quotes, photograph and video, and written work. We will only use Student's name on T-shirts and Programs. *

Agree to Media Consent

I do not wish to share my student's work

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