Old Gregg School Theatre Dept. Registration Form Student Name:__________________________________________________________ Age:________ Birthdate:_______________________________Grade in School As Of 9/07:____________________ School District of Residence:__________________________________________________________ Parent/s Name(if student is under 18):___________________________________________________ Home Address:_____________________________________________________________________ Phone Number:  (H)________________ (W)_____________ (C)____________  (OTHER)__________ E-mail address:____________________________________________________________________ Do you/your child have any medical issues/needs that we should be aware of?                                     _____Yes (please explain)                ____No _____________________________________________________________________________________ Amount of Deposit enclosed (must be at least $20.00 to reserve class space.) _________ I am registering for (circle one):        Novice Actor Class        Practiced Actor Class        Workshop I would like a receipt:    _______Money order*               ______Check *                * All Checks and Money Orders should be made payable to Victoria Brennan 50% of tuition must be paid by the first week of class.  If you need to make special payment arrangements, contact Victoria 349-4467 Once classes begin, full refunds will not be given should student choose not to participate.  There will be registration and processing fees deducted as well as classes attended.  After the 7th week of classes, no refunds will be given.  Any balances can be applied to future classes.  If you have questions, or need clarification please contact Victoria By signing below I am agreeing to all matters in the above agreement.  I will not hold Gregg Township, PVOGSCC, or individuals of it’s boards liable for any incidents, which may result in injury, illness, or possible death.  I verify that the above information is true.  I am accepting responsibility for transportation to and from PVOGSCC as well.  I understand that I am responsible for the full tuition amount, regardless of student’s attendance. ______________________________________________                __________________ Signature of Student                                                        Date ___________________________________________________               _____________ Signature of Parent/lLegal Guardian (if student is under 18)                        Date