| Fall 2007 Theater Class REGISTRATION FORM To Register for a class Fill out this form and Mail it to: Oakland Theatre Guild PO Box 7604 Bloomfield Hills, Michigan, 48302 Make Checks payable to: Oakland Theatre Guild You may drop this form off at the Starlight Theater during Registration. There will be a $10.00 charge per class for late registrations. The Starlight Theater is located inside the Summit Place Mall (between Kohl’s and Claire’s), on the corner of Telegraph and Elizabeth Lake Roads. Call 248-335-1788 with questions. Student Name______________________________________________________________Age______________ Class______________________________________________________________________ Fee ____________ Parent’s Name (If student is under 18)___________________________________________________________ Street Address____________________________________________________________________ City ______________________________________________________ State _____ Zip Code _______________ Home Phone ___________________ Work Phone __________________ Cell Phone __________________ Email address____________________________________________________________________________ Medical problems________________________________________________________________________ _________________________________________________________________________________________ Release: I hereby assume all responsibility for myself and/or my children while participating in activities at Starlight Theater. I waive all claims for liability against Starlight Theater or any of it’s employees or instructors in case of injury. I am the parent or Legal guardian of the above named person. Signature ______________________________________________ Date ____________________________ |
