Payment Information:

 

Registration Fee:                            =$15.00 (Yearly)

Tuition:  Semester                        = $219.00

Multi-child Discount                    -$20.00

Drama Journal                                   = $10.00 (One Time Only)

 

Total = __________________

Full payment required before 1^st class session

Payment by Credit Card- On Line at: www.FinalActDrama.com

Payment by check to be paid to:  Final Act Drama, LLC

Returned check fee = $35

Attach payment to completed Registration Form and mail to:

Final Act Drama

7206 Port Side Drive

Midlothian, VA 23112

Tuition and Fees:

I/we acknowledge and agree that I/we am personally liable for all fees and tuition related to enrollment of my/our child(ren) or ward(s) at Final Act Drama Academy. Furthermore, I/we acknowledge that my/our liability will continue for all periods of enrollment, including renewals of the initial enrollment or any new enrollments. Such liability will continue until such time as I/we provide written notice to Final Act Drama Academy of the fact that I/we will no longer be liable for fees and tuition related to the enrollment of my/our child(ren) or ward(s), in which case I/we shall continue to be liable for all fees and tuition incurred prior to the date of receipt of the written notice by Final Act Drama Academy. I/we acknowledge that any fees and tuition that are not paid by their date shall bear a late fee of $5.00/day and that in the event that Final Act Drama, LLC institutes legal action to recover any amounts due from me/us, I/we will be responsible for all court costs and reasonable attorney fees of 25% of the amount due.

 Initial Here__________

Parental Consent:

I, the minor's parent and/or legal guardian, understand the nature of the above referenced activities and the Minor's experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby Release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses or damages on the minor's account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any Releasee may incur as the result of any such claim.         Initial Here__________

Photo / Interview Release Form:

Final Act Drama Academy staff may photograph students occasionally, with the intent of using the pictures in various publications and/or on our web site (www.FinalActDrama.com). Similarly, Final Act Drama Academy may wish to promote our student's accomplishments by sending press releases to appropriate newspapers or publications. In addition, representatives of the media may be interested in stories relating to Final Act Drama Academy and may wish to interview, photograph or videotape our students. Please complete this form and return it to your teacher. Non-response to this request will indicate that you grant permission as indicated below.

I ___ grant____ do not grant permission for press releases to be distributed about my son/daughter, and for photographs of and/or interviews with my child to appear in other mediums for Final Act Drama Academy.

Student Registration

Because the Final Act is always the best!

Teaching Site: _________________________________

____________________________________________

STUDENT   (separate forms for each child)

____________________________________________

GENDER       M OR F                                                    DATE OF BIRTH   /    AGE

_____________________________________________

SCHOOL ATTENDING                                               GRADE

_____________________________________________

Medical conditions or allergies     (Use back if necessary)

_____________________________________________

PARENT/GUARDIAN #1                                         GENDER   M OR F

_____________________________________________

 ADDRESS

_____________________________________________

CITY                                                                                        STATE/ZIP

_____________________________________________

DAY PHONE                                                                      EMPLOYER

_____________________________________________

EVENING PHONE                                                           CELL PHONE

_____________________________________________

HOME E-MAIL

_____________________________________________

PARENT/GUARDIAN #2                                        GENDER   M OR F

_____________________________________________

ADDRESS             

_____________________________________________

CITY                                                                                  STATE/ZIP

_____________________________________________

DAY PHONE                                                                     EMPLOYER

_____________________________________________

EVENING PHONE                                                   CELL PHONE

_____________________________________________

HOME E-MAIL

_____________________________________________

EMERGENCY CONTACT NAME                         PHONE NUMBER

 

All Major Credit Cards Accepted

Pay your Course Tuition Today!

Release and Waiver of Liability, Assumption Of Risk, and Indemnity Agreement

In consideration of participating in class activities I, the minor's parent and/or legal guardian, represent that I understand the nature of this Activity and that the participant is in good health, and in proper physical condition to participate in such Activity. I acknowledge that if I believe event conditions are unsafe, participant will immediately discontinue participation in the Activity. I fully understand that this activity could involve accidental risks of bodily injury, including permanent disability, paralysis and death, which may be caused by participants own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the "releases" named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility of losses, cost, and damages I incur as a result of participants participation in the Activity. I hereby release, discharge, and covenant not to sue Final Act Drama, LLC, its Respective administrators, directors, agents, officers, volunteers, and employees, other participants, and sponsors, advertisers, and , if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEEES" herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the "releasees" or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save and hold harmless each of the Releassees from any loss, liability, damage, or cost, which any may incur as the result of such claim. I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without an inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extend allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

Name of participant______________________________________________  Parent Initials________