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 ____________________________
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