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Registration Form
Interest: ____Acting___Tech Theatre
SCHEDULE:
Monday–Thursdays, July 5th–August 7th
Performances are Thursday August 5 th, Friday, August 6nd, , August 7th,
Auditions are Tuesday, June 22; Wednesday June 23
at the Hastings Community Center, lower level.
Participants must be able to attend rehearsals and all performances.
Special Concerns:
Continue on back if necessary.
Payment:
Early Bird Special! $100! Send registration and check before June 15th.
After June 15, $150.00. Please send this form and a payment of to
Friends of the Hastings Youth Council,
P.O. Box 64
Hastings-on-Hudson, NY 10706.
Or drop it off at the Community Center Lower level to Jenny Conte, Youth Advocate.
Scholarships available upon request. For more information, please call the Youth Council at 478-2471 or yap@hastingsgov.org
Name ____________________________-__e-mail ______________________________________
Address ______________________________________________________________________
Cell Phone ________________________home phone _________________________________
Age as of July 5 _________ Grade Entering________________________________________
Name and phone of Emergency Contact Person______________________________________
Relation to Emergency Contact Person_____________________________________________
In consideration of your accepting this permission slip, I, the undersigned, for myself, my executors, administrators, and assignees, do hereby release and discharge the Hastings Youth Advocate Program, from any and all claims of damages, demands, action and causes of actions whatsoever, in any manner arising or growing out of my participation in said program. I further attest that I am physically qualified to participate in this program.
Signature of Guardian (or participant if 18 or over): date:
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