Registration Form

Registration Form
Nov 18, 19, 20, 2011
Lakeshore High School Community
DFP use
Please send current photo of registering
student with this form
Student's Name (and/or nickname)
Home Phone Number
Street Address
Date of Birth
Parents Names
2nd email
Mom's Work Place
Mom's Work Phone
Mom's Cell Phone
Dad's Work Place
Dad's Work Phone
Dad's Cell Phone
Emergency Contact Name (nearest Friend or relative)
Emergency Contact Phone
Emergency Contact add'l No.
Rehearsal (times vary)
13 The Musical
6th - 12th
Saturdays 12:30-4
There is no Rehearsal CD. We recommend you purchase the
Broadway Soundtrack to familiarize yourself with the music.
Optional: Student Book with dialogue and music - N/A at this time
"13 The Musical" T-shirt
Select Size*
Optional: Contribution to KOS Scholarship Fund
*Additional T-shirt sizes may be ordered at checkout
Kids On Stage Policies
1. Cancellation Policy: If you cancel your registration with less than
a two weeks' notice before the class begins, no refund will be given.
2. $50 of tuition is non-refundable.
3. There will be no refund after August 27, 2011
4. Cancellation by KOS: We reserve the right to cancel a class if
enrollment is insufficient. Any tuitionpaid will be refunded in full.
5. Please do not send your child to class if he/she is not feeling well.
Sub-Total Fees
Early Bird Discount
on or before Sept 6
Scholarship applied
requires prior approval
Total Fees
*There will be a 4% processing fee added to all payments made by credit card. See bottom of page two for other payment options.
Parents - Please Read and Sign the following Waiver
By signing below, I agree to release and discharge Doug Fordyce Productions, LLC and its officers, directors, employees, volunteers and
agents of and from any claims, demands, or liability of damage arising from the participation of my student in any classes or programs
sponsored by Doug Fordyce Productions, LLC. I also give permission to Doug Fordyce Productions, LLC, without limitation or obligation,
to photograph or video my student in relation to their participation with Doug Fordyce Productions, LLC. Photographs or video may be
used for archival or promotional purposes. I also agree that there will be no registration refunds after August 27, 2011.
I also agree that by registering my student and signing below, they WILL attend the MANDATORY rehearsals and all performances
in their entirety. Mandatory rehearsals are: Nov 12 (8:30-5:00), and Nov 14 & 16 (4:30-8:00); Performances Nov 18 & 19 (7pm), Nov
20 (5 pm) . PLEASE DO NOT REGISTER YOUR CHILD if they will fail to attend any one of these without prior permission to miss.
Typed name represents Parent/Guardian Signature
Please list any scheduled vacations or other conflict dates the student will NOT attend rehearsal:
for kids:
We want to know about you and your theatre experience (It's ok if you don't have any experience, but feel free to brag)
Name some plays you've been in, or roles you've had and the group or school you did it with:
Any formal training in Dance? Gymnastics? Other? How much training (example 3 yrs. ballet, 2 yrs gymnastics):
Name your singing experience and training (if you've had some):
What are your interests and goals in theatre?
Why do you want to attend KIDS ON STAGE?
What are some of your hobbies, other than theatre?
Name some of your favorite Singer/Songs, Website, etc.
for parents:
Where did you hear of KIDS ON STAGE? (Select from list or type in your answer)
Is the Orientation meeting on your calendar for Sept 10 at 3:00 pm?
Do you have a theatrical background? Care to elaborate?
If you are interested in Volunteering during the production, check of any of the areas you are interested in - or type your suggestion here:
Make Up
Stage Crew
Bake Cookies
Child Supervision
Set Construction
Shoe Coordinator
Tech Week Dinner Help
Cast Party Organizer
Payment can be made in one of three ways:
1. Print this completed form and mail with check payable to DFP, PO Box 224, Stevensville, MI 49127
2. Fill out form, note the total fee, then go to
and pay with your credit card.
(If you have trouble submitting the form by email, try using a different browser)
3. Go to and pay with credit card. A 4% processing fee is added.
Be sure to print and save a copy of this form for your records.
Print Form