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Enrollment Form
CHILD'S INFORMATION
*
Indicates required field
Name of Child
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First
Last
Date of Birth
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Address
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Line 1
Line 2
City
State
Zip Code
Country
School
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Grade as of 2019-2020
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1st
2nd
3rd
4th
5th
6th
7th
PARENT(S) INFORMATION
Mother's Name
*
First
Last
Mother's Email
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Mother's Cell
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Mother's Office
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Father's Name
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First
Last
Father's Email
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Father's Cell
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Father's Office
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MEDICAL INFORMATION
Emergency Contact Name
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First
Last
Relationship
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Home Phone
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Cell
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Doctor's Name
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First
Last
Doctor's Phone Number
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Insurance Company
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Policy #
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My Child May Be Given
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Tylenol
Advil
Tums
Medications Being Taken
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Medical/Allergy, Social/Emotional issues that you feel our staff should know
*
CARPOOL CONTACTS
My child may be picked up by the following people (other than parent/guardian)
Carpool Pickup #1 Name
*
First
Last
Carpool Pickup #1 Home Phone
*
Carpool Pickup #1 Cell
*
Carpool Pickup #2 Name
*
First
Last
Carpool Pickup #2 Home Phone
*
Carpool Pickup #2 Cell
*
PARENT AGREEMENT
There are no makeup days or refunds for absence due to sickness or other reasons.
There are no sessions on July 4th & July 5.
I will bring my child to the workshop by no later than 9:00am and pick him/her up promptly at 3:00pm.
I will provide 2 snacks, lunch, and water each day (no shellfish, pork, or nuts).
I authorize Broadway Kids LA to use any photographs or videos taken in promotion, marketing, program materials, and media.
To ensure my child's space, a $400 non-refundable deposit, along with this Enrollment Form and Permission Agreement, is required. The remaining tuition balance is due by April 20, 2019.
For enrollment after April 20th, only FULL TUTION is accepted.
Tuition is no longer refundable after April 20, 2019.
I understand that casting decisions are made by the Directors and are final. I support the casting decisions made by the Directors.
By entering your name and date below, you acknowledge that you have read, understand, and accept the policies stated above.
Name
*
Date
*
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Broadway Kids LA