Registration Form for

BROADWAY BRATS!

and

T e e n   T h e a t r e

It's all about KIDS!

• NOTE: This is not an automatic electronic registration form.
  Print this form (press the print icon on your browser) and send it to NYT.

• Mail check & form to:

  • Northwest Youth Theatre, 1667 SW Cherry Park Rd, Troutdale OR 97060.

• Registration must be accompanied by non refundable deposit of $10.

• Tuition assistance is available to families who qualify. CLICK here for more info.

• Tuition may be paid monthly. A 10% discount is offered for advance payment.

• Classes meet each Tuesday

• Northwest Youth Theatre is a 501(c) 3, not-for-profit corporation.

Student’s Name:

Address:

City:

State:

Zip:

eMail Address:

Grade:

Sex:

Parent(s) Names:

Home Phone:

Cell Phone:

Emergency Contact Name:

Phone:

Choose ONE

Grade Level

Days

Time

Fee

q  Broadway Brats

1st - 3rd Grade

Tuesdays

5-6 pm

$30/month

q  Broadway Brats

6-7 pm

Method of Payment (circle one):

Check (enclosed)

MasterCard

Visa

Card #

Exp. Date:

Signature:

PLEASE READ AND SIGN THE FOLLOWING:
I, the undersigned parent or guardian of this student, a minor, do hereby authorize the directors, staff and teachers of Northwest Youth Theatre as agents for the undersigned to consent to medical treatment in an emergency. I hereby release and discharge NYT from any and all claims for personal injuries.  Additionally, I agree that photographs of this student taken during workshop hours may be used for promotional purposes by NYT, but will not be used by other organizations without additional written consent.

 Parent/Guardian Signature:

Date: