Print and mail registration to MASTER ARTS THEATRE, 75  77th St SW, Grand Rapids, MI 49548

OR, call to register by phone using a MasterCard or VISA! (616) 455-1001

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2010 Registration Form: Fall Classes @ Hudsonville

Student Name:___________________________________________________________

Sex     M     F                         Age _____                 Birth Date:____/____/____

Grade _____

Parent or Guardian's name(s):__________________________________________

Home phone: (______)_______________    Daytime phone: (______)_______________

Address:__________________________________________

City, state, Zip: __________________________________________

Email:_____________________________________

[   ] Monkey See, Monkey Do (Ages 4 - 6)      $95
          10 Weeks beginning, Tuesday, September 14, 4:15 - 5:30 PM

[   ] LEAP! (Ages 7 - 11)      $95
          10 Weeks beginning, Tuesday, September 14, 4:15 - 5:30 PM

[   ] Mad Theater Skills (Ages 12 - 16)      $110
          10 Weeks beginning, Tuesday, September 14, 4:15 - 5:45 PM

Payment due to secure registration:

Enclosed is my check for $________________, payable to Master Arts Theatre. I hereby release, absolve, indemnify and hold harmless the Master Arts Theatre directors and staff members; and in case of injury during normal routines and activities outlined above, I hereby waive all claims against the above. I assume all risk incidental to the conduct of these activities and transportation to and from Master Arts activities. In case of injury during camp hours call:

_______________________ at (_____)_______________ (ph#)

and/or our family physician:

_______________________ at (_____)_______________(ph#).

Parent or Guardian Signature: __________________________________   Date: ________