Please print this form, fill it out completely, and the return it to:
Clown Classes
Greenbelt Arts Center
P.O. Box 293,
Greenbelt, MD 20768.
Questions? Visit our website at www.greenbelt.com/artscenter.
or call us: Phone: 301-441-8770. Email: artscenter@greenbelt.com
Parade Theatre # of Students________
X $90 = ________
TUESDAYS 3:00-5:00 --Ages 9-12
STUDENT NAME(S) |
AGE(s) |
________________________________ |
_____________________ |
________________________________ |
_____________________ |
WEDNESDAYS 3:00-5:00 --Ages 10-14
STUDENT NAME(S) |
AGE(s) |
________________________________ |
_____________________ |
________________________________ |
_____________________ |
THURSDAYS 4:30-6:30 --Ages 13-18
STUDENT NAME(S) |
AGE(s) |
________________________________ |
_____________________ |
________________________________ |
_____________________ |
MASTER CLASS FOR ACTORS # of Students________ X $200=________
CLOWN INTENSIVE
MAY 7-MAY 11 10:00 AM &endash;1:00 PM EACH DAY
Maximum 8 students COST $200
STUDENT NAME(S) |
AGE(s) |
________________________________ |
_____________________ |
________________________________ |
_____________________ |
Total Due $_____________
Please pay with check or money order payable to The Greenbelt Arts Center
Information:
(If student(s) is(are) under 18 years of age, the following should be the parent/guardian information)
Name: ___________________________________
Address: _________________________________
City, State, Zip: ____________________________
Phone Number:____________________________
RELEASE AGREEMENT
Although every effort is made to provide a safe environment, I recognize there is always a risk of accident. I agree to be responsible for any medical bills incurred resulting from illness or injury during my or my child's participation at GAC. Students are expected to carry their own accident and medical insurance. I release GAC from any and all liability and/or claims or damages arising out of personal injury of any kind. If necessary, I authorize the Greenbelt Arts Center (GAC) to administer first aid and/or authorize medical treatment for me or my child.
I have read and accept all of GAC's policies and the release agreement.
____________________________
Signature (of Parent or Guardian if Student is under 18)