| 2011 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 Arts 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 at 7370 Highland Road, Waterford, MI 48327. 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 ____________________________ |
