Student's Name *
Birthday *
MM/DD/YYYY
Students must be 14-19 to be eligible for our teen program.
Grade in 18/19 School Year *
 8 
 9 
 10 
 11 
 12 
 College 
Parent/Guardian Name(s)
Please fill in up to two parent/guardian FULL names.
Home Address *
City *
Zip code *
Home Phone Number *
numbers only, no spaces, - or ( )
Cell Phone Number
numbers only, no spaces, - or ( )
Parent Email
Student Email
Previous Drama/Dance Experience?
 Yes 
 No 
If yes, please list production(s)/location(s)/role(s)
Desired Role/Responsibility *
 Actor/Actress 
 Stage Crew 
 Design 
 Sound/Lighting 
Does your child have any medical needs/conditions/allergies that the
staff should be aware of?
*
 Yes 
 No 
If YES, please explain
Does your child have a prescribed epi-pen or inhaler? *
 Yes 
 No 
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Cell
You must agree with our policy statement in order to register. *
I, the undersigned, hereby indemnify, defend, and hold harmless Teen Drama, its directors, agents, and employees and other officials from any claims, including: liability, loss, damage (to persons or property) and expenses (including attorney fees), which may arise as a result of my child’s participation in this program. Photographs of my child can be used for program promotion. Also, I give permission for my child or me to receive emergency medical care. I understand there are no refunds for missed classes or performances after June 25. Multiple children discounts apply to children who reside at the same address. I understand there is a $20 fee for checks returned to Teen Drama by the bank. Students are required to attend all rehearsals and performances. Three unexcused absences will result in non-refundable dismissal from Teen Drama. 15 minutes late is considered tardy. Two tardies are equivalent to one absence. Appropriate behavior and attire are expected. If a student is released because of misbehavior, at a staff member’s discretion, the release will count as an absence. Two behavior releases will result in dismissal from Teen Drama. Casting is not guaranteed. All casting decisions made by the staff are final. Space is limited; participants will be registered on a first-come, first-serve basis.
Please Enter Parent/Guardian initials as electronic signature *
Method of Payment
Cash can only be paid in person at our open registration day or on the first day of class.
Check and Money order can be mailed or provided on the first day of class.
PayPal/Credit Cards are processed online after registration is complete. PayPal can also process electronic checks or debit cards. You will receive an invoice from Teen Drama with payment methods.
How did you hear about us?
 Word of mouth 
 Search Engine 
 Advertisement 
 News Article 
 Local Media 
 Web Site 
 Facebook 
 W.H.A.T. 
 Other 
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