Please provide the following information (all information is kept confidential):

Student
Parent(s)
Address
City
State   Zip
Phone
E-mail

   Which camp will you attend?

Movement & Dance Rats!              
Hip Hop Once on this Island Jr.
EiEi Ooops    

Medical Consent and Release of Liability  
By sending this electronic form to NYT you are stating that you are the parent or guardian of this student, who is a minor.  Additionally, you authorize the directors and teachers of Northwest Youth Theatre (NYT) to act as agents for you and consent to medical treatment in an emergency situation. You hereby release and discharge NYT from any and all claims for personal injuries. You also agree that photographs of this student taken during workshop hours may be used for promotional purposes by NYT, but will not be used by any other organization without your prior written consent.  

Receipt of this electronic submission is your signed consent.

Payment Information
All enrollments processed electronically must include an online payment. We use PayPal as our secured service provider so you may use your PayPal account, or pay with a credit card.  We currently accept Visa & MasterCard. Each enrollment must include a non-refundable $20 deposit for every class.  Full payment is due before the first day of class. Once we receive notification from PayPal that your registration has been processed we will send you a post card to confirm your child's enrollment.

REFUND POLICY: Full refund if class is cancelled by NYT. Tuition, less non-refundable $20 deposit, will be refunded up to second class session. After second class session, no refunds will be given. Tuition assistance is available.

                       

Copyright © 2004 Northwest Youth Theatre. All rights reserved.
Revised: June 08, 2004