KPAC young artists

MIDDLE SCHOOL

Summer 2016 Registration Form

Program fee - $20.00 (includes performance t-shirt)
(Checks payable to KPAC/City of Paris)

Student Name __________________________________________________________________ Age _______

Mailing address ________________________________________________City________________________
Parent(s) or Guardian(s) ____________________________________________________________________
Mailing address (if different) _________________________________________________________________
Phone numbers in order of preference _________________________________________________________
_________________________________________________________________________________________
Parent e-mail ______________________________________________________________________________
Student e-mail (if desired) ____________________________________________________________________
Emergency contact _________________________________________________________________________
Any important medical information? ___________________________________________________________
_________________________________________________________________________________________

June 7-10, 2016 Tuesday through Friday

2:00 to 5:00 p.m.
Closing Concert, Friday, June 10, 2016 5:00 p.m.
Sponsored by City of Paris Parks & Recreation
Financial assistance available for those who qualify Please inquire to rhonda.stanton@parisssd.org

The KPAC young artists Middle School Band Camp t-shirt has the band camp logo
on front and is plain on the back.
Parents or family members can show support by purchasing additional shirts for $15.00.
Students or parents can put a name/nickname on the back of the shirt for an additional $5.00.

KPAC young artists

Plain Back ____ Name on Back ____ (check one)

Please print text for back ________________________________
Check Sizes:

____ Youth XS (2-4)

____ Youth S (6-8)
____ Youth M (10-12)
____ Youth L (14-16)
____ Adult Small
____ Adult Medium
____ Adult Large
____ Adult X-Large
____ Adult XX-Large

KPAC Young Artists

Photo Authorization
KPAC Young Artists Theatre acquires photos during the course of each production.
Parental permission is requested in order for us to display the photos of minors.
Please know that KPAC staff will always strive to only present photos of your
children in an appropriate, positive light. Photos are frequently used in the
following ways:
In the program playbill
On the official Krider Performing Arts Center Website and the associated City
of Paris, TN Website
On the official Krider Performing Arts Center Facebook Page and/or the
official KPAC Childrens Theater Facebook Page
In the local media as news or promotional material
In promotional or nostalgic media for Krider Performing Arts Center
____ Yes, I give permission as parent or guardian of the named minor child for
Krider Performing Arts Center and/or the KPAC Young Artists Program to
present photographs as described above.
____ No, photographs of the named minor child may not be used.

____________________________________________
Name of Participating Minor

____________________________________________
Signature of Parent/Guardian

____________________________________________
Date