‘The Studio’ Summer 2011 Registration
Note: Please fill one one form for each participant.
Location: The Studio, Wellington Hall Academy, 3rd Floor, Ignatius Jesuit Centre, 5420 Hwy #6 N.
Tuesday: (July 12, 19, 26)
Teen Acting 6:00-7:00pm $30.00
6:00-7:00pm $30.00 Teen Broadway Jazz 7:00-8:00pm $30.00
$30.00 Wednesday: (July 13, 20, 27)
Music Theatre Workshop I 6:00-7:00pm $30.00 (Mary Poppins)
Music Theatre Workshop II 7:00-8:00pm $30.00 (The Boyfriend)
Thursday: (July 14, 21, 28)
Ballet I (junior) 6:00-6:45pm $30.00
Ballet II (intermediate) 7:00-8:00pm $30.00
Ballet III (pre pointe) 8:00-9:00pm $30.00
Class:_______________________ Fee:__________
_______________________ Fee:__________ _______________________ Fee:__________ _______________________ Fee:__________ _______________________ Fee:__________
Total Payment:_______ Payment Options: Cheque/Money Order made out to JBMentertainment
New: Email Interac Payment to: info@jbmentertainment.com
How did you hear about The Studio’s Camps & Classes?_______________(referral?)_________________
Student’s Name:__________________________________ Age:___________ D.O.B.:_____/_____/_____
Sex: Male:______ Female:______School: ___________________________________________________
Home Address: __________________________________ City: _______________ Postal Code: ________
Telephone: Day: _____________________Evening: ____________________ Cel: ___________________
Email: _________________________ Payment: Cash:_____Cheque:_____MO:_____MC: _____Visa:_____
Emergency Contact: ___________________ Relation: __________Telephone: ______________________
I desire that the child named above participate in Summer at the Studio and all their activities, unless I advise the school Director otherwise in writing. I agree that, having taken the precautions that, in your discretion, are deemed advisable, the company and its staff will not be held responsible for any sickness or accident to my child. If for any reason my child requires medical attention beyond that furnished by the company, I agree to be responsible for any expense incurred. I covenant and agree to indemnify JBMentertainment & Wellington Hall Academy, it’s employees, director and staff and save them harmless from and with respect to all suits, actions and prosecutions by reason of any activity carried out by my child, whether on or off the premises at which the classes are held.
Parent/Guardian Signature: __________________________________________Date:_____________________
Please send completed Registration Form and Payment to:
JBMentertainment, Jeffrey Morden-Director, 534 McTavish Street., Fergus, Ontario, N1M 3P9
info@jbmentertainment.com
