Registration

Child's Information:

Name

Date of birth

age

School

Grade level

Parent/Guardian Information:

Name

Address

Phone

Emergency Contact Information:

E Name

EPhone

E Name

EPhone

E Name

EPhone

Medical Information:

Allergies

Medical Conditions

Medications

Physician's Name

Authorized Pick-Up:

Authorize pickup

Liability Release

I have read and agree to the ACT Liability Waiver and Release Form.

photo release

I give permission for photos/videos of my child to be used as described in Photo & Video Release Form.

A Children's Theatre of the Mesilla Valley