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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2012 Registration Form: Winter 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:_____________________________________
(Ages 9 - 11), 4:15 - 5:30 PM
[ ] Got Talent, Jan 17 - Feb 21 $57
(Ages 12 - 16), 4:15 - 5:45 PM,
[ ] So You Want to be a Character, Jan 17 - Feb 21 $65
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: ________