Student Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent/Guardian Name *

If adult, write your own name.

First Name

Last Name

Contact Phone Number *

(###)

###

####

Alternate Phone Number

(###)

###

####

Does the student require emergency treatment for these allergies? *

If yes, additional paperwork will need to be filled out for our administration to keep on file.

Yes

No

We must receive your payment by the closing registration date of your class, or your spot will be forfeit to the students on our waiting list. Payments of cash or checks can be made at a registration day in the Stage Door Box Office, or mailed to: JRT Education, P.O. Box 585, Jonesborough, TN 37659. Please include parent's name, student's name, and intended class in envelope. *

I understand that my spot will not be reserved if my payment is not received by final day of registration.

By signing below, the parent/guardian/participant shows they have read, understood, and agreed with the terms on this registration form and the schedule. Participants must commit to being consistently present, on time, and performing in the final class production. *

By signing this form I (we) agree to the following: (1) program participant and any guests in his/her party will abide by the terms of this agreement at all times during the period of enrollment and will comply with all rules and regulations posted or otherwise communicated to participant, (2) in case of illness or injury, The Town of Jonesborough (TOJ) is authorized to secure emergency medical treatment at the participant's expense, (3) TOJ reserves the right to remove from the facility or terminate the membership/program enrollment of any participant who fails to comply with any posted rules and regulations or otherwise breaches the terms of this agreement, in which case participant will not be entitled to a refund, (4) program participant rights are not transferable and (5) grant permission for TOJ to make visual recordings of individual listed on this form for its responsible use, (6) no refunds can be given. LIABILITY WAIVER - I understand that use of the facilities and equipment at TOJ may involve risk of bodily injury or property damage and I agree to assume any such risks. I also understand and agree that by signing this agreement, I am giving up my right (or that of the minor for whom I sign) to make any claim against TOJ, its agents, employees, and volunteers, including the right to sue them, for bodily injury or property damage or any other loss that I might suffer while using TOJ facilities and services, except as limited by law. EMAIL CONSENT - By including my email on this application I am opting in to receive emails from TOJ. We will never disclose your email address to anyone. PHOTO RELEASE - I hereby give permission for me or my child and artwork produced to be photographed/videotaped with the possibility of being used in publicity and commercial purposes for TOJ and I give exclusive right to these photos/videos to TOJ and waive all claims of compensation for usage. Class registration fees are non-refundable.

First Name

Last Name