Registration Form for

2005 Summer Theatre Camps

It's all about KIDS!

June 27th - July 1st
	A Disney Jamboree	9:30am to Noon	$50
	The Emperor's New Clothes	1:00pm to 3:30pm	$50
July 5th - 8th
	KinderDrama	10:00am to 11:00am	$25
July 18th - 22nd
	At the Hop!	9:30am to Noon	$50
	It's Saturday	1:00pm to 3:30pm	$50

Student Information

Student Name
Parent(s) Name
Address
City/St/Zip
Phone #s	Work Home
E-Mail
Emergency Contact	Phone #
Medical Information

Medical Consent and Release of Liability

I, the undersigned parent or guardian of this student, a minor, do hereby authorize the directors and teachers of Northwest Youth Theatre (NYT) 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. 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.

Signature _________________________________________ Date ________________

Payment Information

To secure enrollment, please send a non-refundable $20 deposit for each class. Full payment is due before the first day of class. 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. Call the NYT Business Office at 541-891-0471 to receive a Tuition Assistance Form or click here to access the form on-line.

Payment Method	(Select One)	No. of Classes
Amount Paid	$
Card # Exp. Date:

Signature _____________________________________________________

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Mail completed form to:

    Northwest Youth Theatre
    1667 SW Cherry Park Road
    Troutdale, OR 97060