Pure Imagination Registration
Theatre Camp & Pure Imagination Production
Performer Name
*
First Name
Last Name
Age
*
Birthdate
*
Example: 4/30/2015
Briefly explain prior class/ performnace experience. Or upload resumer below.
Upload a performance resume.
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Upload a headshot or photo
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Performer Phone {if applicable}
-
Area Code
Phone Number
Performer email {if applicable}
example@example.com
Please share any health or learning conditions.
*
Help us meet the needs of our cast members. (If none write none)
General Contact Info
Parent or guardian
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Parent email
*
You will receive program info through this e-mail address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Waiver of Liability & Photo Release
By signing below I agree and understand that T3 activities involve physical activities and may have a small risk of injury. In consideration for my child’s participation in this activity, I hereby agree to hold T3 Triple Threat Youth Mentors (T3), or any of its affiliates harmless for any injury to myself/my child resulting from me/my child’s participation. I will not sue T3 or any of its affiliates for any injury, loss of property, or damage resulting from my child’s participation in this activity. I agree that participants are expected to follow all rules and instructions set out by the instructors at T3. Additionally, I give my permission and understand T3 may use any photos and video footage taken for future promotional purposes.
Please tell us how you found us. This will help us do more of the things that are working well.
*
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Pure Imagination
(
$
150.00
for each
month
)
Pure Imagination tuition 3 payment of $150
Total
$
0.00
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