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 or 1-800-455-5003

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2008 Registration Form: Walker Fall Classes

Student Name:___________________________________________________________

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

Entering grade _____

Parent or Guardian's name(s):__________________________________________

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

Address:__________________________________________

City, state, Zip: __________________________________________

Email:_____________________________________

[   ] Start up Acting (Ages 6 - 9)      $95
          10 Weeks beginning, Monday, Sept. 15, 4:00 - 5:15 PM

[   ] Acting Today (Ages 10 - 12)      $95
          10 Weeks beginning, Monday, Sept. 15, 4:00 - 5:15 PM

[   ] Improvisation (Ages 13 - High School)      $110
          10 Weeks beginning, Monday, Sept. 15, 4:00 - 5:30 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: ________