Purdy-Quinlan Studios - Registration

Registration Form
Student First Name:
Student Last Name:
SELECT PROGRAM
Children's Theatre Workshops: Mondays 4:00 to 6:00 Thursdays 7:00 to 9:00 Saturdays, 10:30 to 12:30 Saturdays, 1:00 to 3:00	On-Camera Acting and Auditioning Techniques Monday - 4:00 to 6:00 Tuesday - 4:00 to 6:00 Wednesday - 4:00 to 6:00 Thursday - 4:00 to 6:00 Friday - 4:00 to 6:00
"Making it in the Movies in Massachusetts - the Reel Deal" Dates to be announced	"Star of the Day" April Vacation Camp Monday Tuesday Wednesday Thursday Friday
Gender:	Male Female
Birth Date:
Street:
Town or City:
Zip:
Home Phone:
Cell Phone:
Emergency Contact Name:
Emergency Phone:
Email Address:
How did you hear about us?
What school does your child attend:
Parent or Guardian Name:
Parent or Guardian Address:
I understand I’m responsible for the full tuition unless I withdraw my child right after the second class (not applicable to one day classes):	Yes No
I give my permission to a Staff Member to drive my child home, if the need arises:	Yes No
I give permission for a Staff Member to call my child’s doctor or bring my child to an Emergency Department, if necessary:	Yes No
Doctors Name:
Doctors Phone:
Doctor's Address:
I understand that Purdy-Quinlan Studios and Diane Purdy's Children's Theatre Workshop, Inc. and its affiliates are not responsible for any injuries my child may sustain due to his or her inappropriate actions or behavior. I also understand that if my child is too disruptive to handle, we may ask him/her to withdraw:	Yes No
Are you involved in or contemplating a lawsuit concerning your child?	Yes No
Would you like to be involved in one of our Volunteer Committees?	Yes No
If yes please list your interests Fundraising Sewing Ironing Marketing Set Building Props Hair Makeup Cleanup:
Is there any personal information we should know or be aware of:
Please use this space for questions and comments regarding the Studio programs:

Purdy-Quinlan Studios
OFFICE: 15 Middle Street, East Weymouth, MA 02189 REHEARSAL STUDIO: Trinity Church, 241 Broad Street, Weymouth, MA 02188
781-331-2700
© 2005 Purdy-Quinlan Studios.com