Registration Form - Doug's Kids on Stage

DFP use
Located at The Orchard's Mall
1800 Pipestone Rd., Benton Harbor,MI
March 20,21,22,27,28,29,2015
Registration Form
Student's Name (and/or nickname)
Home Phone Number
Street Address
Date of Birth
Parents Names
email - Parent
2nd email - additional parent or student
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 Relative/Friend)
Emergency Contact Home Phone
K - 12
$189 if payment received on or
before 12/06/14. $269 after 12/06
Emergency Contact Mobile
Rehearsal CD: Mandatory with registration
Actor's Script: Optional
Required: Makeup kit (if you previously purchaseda makeup kit
change amount in "Fee column" to $1 for new sponges)
"Shrek Jr." T-shirt
*Select Size
Optional: Contribution to KOS Scholarship Fund
*Shirts may be ordered later - deadline will be announced
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. $50 of tuition is non-refundable. There
will be no refund after Dec 31, 2014 Cancellation by KOS: We reserve the right to cancel
a class if enrollment is insufficient. Any tuitionpaid will be refunded in full. Please do not
send your child to class if he/she is not feeling well.
Note: There is a 4% processing fee added to all payments made by
credit/debit card. See bottom of page 2 for other payment options.
Sub-Total Fees
Scholarship applied
requires prior approval
Total Fees
Parents - Please Read and Sign the following Waiver
By signing below, I agree to release and discharge Doug Fordyce Productions, LLC and its offiers, 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 Dec 20, 2014
I also agree that by registering my student and signing below, they WILL attend the MANDATORY rehearsals and all performances in
their entirety as listed on schedule information. PLEASE DO NOT REGISTER YOUR CHILD if they will
fail to attend any one of these mandatory rehearsals 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)
I put the parent orientation meeting,Jan 3 at 1:30pm on my calendar.
No but I will email or call you for an appointment
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
Child Supervision
Stage Crew
Set Construction
Tech Week Dinner Organizer
Bake Cookies
lClean-up/Janitorial 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 (no extra fees)
2. Fill out form, note the total fee, then go to
and pay with your credit card. A 4% processing fee is added.
3. Call Doug 269-313-2795 with your credit card number. A 4% processing fee is added.
Be sure to print and save a copy of this form for your records.
Print Form