Conservatory Program: Annual Enrollee

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Child / Registrant Information

First Name:

Last Name:

Gender:

Date of Birth:

Name of School:

Grade for 2020-2021 School Year:

How are you (the purchaser) related to the student?

Medical Information

Physician Name:

Physician Phone Number:

Date of Last Tetanus Shot:

Does your child have any allergies (food, medication, etc) or dietary restrictions? If yes, Please list ALL below. If no, please write 'none'.

Does your child regularly take any medications that we should know about? If yes, please list below. If no, please write 'none'.

Does your child have any other medical concerns we should know about (ie injuries, chronic health problems)? If yes, please list below. If no, please write 'none'.

Does your child wear glasses or contacts?

Parent / Guardian Information

Please enter your information below.

Name

Address:

City:

Country

State/Prov:

Postal Code:

Primary Phone Number:

Primary Email Address:

Relationship to Student:

Alternate / Emergency Contact Information

Alternate/Emergency Contact Name:

Relationship to Child:

Alternate/Emergency Contact Phone:

Waiver

PHOTO RELEASE: Occasionally, ATMTC photographs and/or videotapes its programs. Photos and videos are used for many different purposes including publications, advertising, and promotional materials. Checking the box below grants permission to ATMTC to use photographs/video of your child while participating in our programs for these purposes.

Yes I understand and accept the above Photography Waiver.

Adventure Theatre MTC assumes no liability for injury or damages arising from the result of participation in its classes, workshops, camps or programs unless due to gross negligence or willful fault on the part of Adventure Theatre MTC. I hereby approve my child's participation in this activity and consent to emergency medical treatment for my child on my behalf. To the best of my knowledge, there are no physical or other conditions that may interfere with my child's participation.

Yes I understand and accept the Liability Release.

I have read, understand, and accept ATMTC Academy's Refund Policy.

Yes I agree.

I have read, understand, and accept all of the ATMTC Academy Class Policies and Procedures and am aware that they are strictly upheld by ATMTC.

Yes I agree.

Have a promo code? All promo codes must be entered BEFORE adding items to your cart. If the promo code is not being applied, please clear your cart, login, and try again. Any questions, contact our Academy at 301.251.5766.

Available Sections

Pay It All Now Price $3,400.00

Pay It All Now Price $3,400.00

Child / Registrant Information

Medical Information

Parent / Guardian Information

Alternate / Emergency Contact Information

Waiver

Leon Seemann

Chil Kong

Margo Brenner Collins

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Pay It All Now Price $3,400.00

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Pay It All Now Price $3,400.00

Additional items

Child / Registrant Information

Medical Information

Parent / Guardian Information

Alternate / Emergency Contact Information

Waiver

Leon Seemann

Chil Kong

Margo Brenner Collins

Connect

Policies

Explore

Directions

Professional Audition Info

Student Audition Info

Box Office/Main

Academy