Summer Shakespeare Intensive Registration Form — Creative Arts Council of Wells County


Summer Shakespeare Intensive
Contact Information
Student's Name *
Student's Birth Date (if under 18)	// (mm/dd/yyyy)
Parents' Name(s)
Address
City
State/Province
Zip
Phone *
Email *
Emergency Contact
Emergency Contact Phone Number
Waiver
I, the undersigned, do not hold Creative Arts Council of Wells County (Creative Arts) or any of its staff or guest faculty responsible for any accident that may happen by nature of the physical, athletic activity engaged in while attending classes, rehearsals or performances at Creative Arts or off site. I hereby authorize the instructor/staff of Creative Arts to act for me in any emergency requiring medical attention, if the above responsible adult(s) cannot be reached. I understand that all participating students are required to have their own accident insurance coverage. I understand, further, that photographs and recordings of students are sometimes used by Creative Arts for promotional purposes. These may include: website, social media, newspaper, television, etc. I understand the risks involved by participating in Creative Arts programming during the COVID-19 pandemic. Because of this, I will not hold responsible the Creative Arts Council of Wells County, its staff, volunteers, board, or instructors if I contract COVID-19. I understand students should not attend Creative Arts programs if they have experienced COVID-19 symptoms (coughing, shortness of breath, etc.) within the last 72 hours, had a fever within the last 72 hours, and/or has been exposed to someone with COVID-19 within the last 10 days. I understand Creative Arts will add my contact information to email campaign/text messaging software in order to communicate information to me about Creative Arts programming. By signing this agreement, I give the Creative Arts Council permission to use my contact information for these purposes. I understand I am able to opt out of receiving both emails and text messages at any time. I agree to pay tuition in full at the time of this registration or to pay the Creative Arts office by phone or in person in order for my spot to be held. I understand tuition is non-refundable.
By checking the box below, I agree to the above listed terms and conditions established by the Creative Arts Council of Wells County, and acknowledge that checking this box will act as a digital signature.
*	I agree.
Payment
Suggested Donation Amounts *	Pay $100 Tuition Fee plus 3% convenience fee Alternate Payment Option