REGISTRATION FORM

Fall___ Spring___ Summer ___

Please print!
Students First Name __________________________________________ Last Name ____________________________________________
Date of Birth ___________________Age _____ M ____ F ____ School _______________________________________________Grade ______
Parent/Guardian Name(s) _______________________________________________________________________________________________
Street Address/Apt. # __________________________________________________________________________________________________
City ________________________________________________________________________________State _____ Zip __________________
Home Phone __________________________________________________Cell Phone ______________________________________________
Work Phone _______________________________________________ Email Address ______________________________________________

Write in SoDA Class Name

New Student
Registration
Fee $20

Returning
Student
Class Fee
$20/hr

Gift/Donation to
SoDA
Scholarship Fund

Total

CLASS:

CLASS:

CLASS:

CLASS:

CLASS:

CLASS:

Method of Payment:

MasterCard

Visa

Check

Cash

Credit Card #

Online
Exp. date

Emergency Contact:
Name: _________________________________________________ Relationship __________________________ Phone _____________________
I understand that in the event of an emergency PRT/SoDA will make every effort to reach me but if that is not possible, they have my permission to seek appropriate medical care through Community Hospital of Monterey Peninsula. I understand that Pacific Repertory Theatre and SoDA will not be held responsible for any
medical expenses for me or my child.
Parent/Guardian Signature ____________________________________________________________________

Standards of Student Behavior Please read and sign this agreement:

I understand and agree that I am expected to behave in a respectful manner towards all SoDA instructors, students, materials, and locations at all
times. My right to attend class(es) can be revoked should I not adhere to a proper behavior code. Student Signature
__________________________________Date ______________
Photo/Video Release For valuable consideration received, I hereby grant to SoDA and its legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs/videos of my child in class at SoDA, for editorial trade, advertising and any other purpose and in any
manner and medium; and to alter the same without restriction. I hereby release SoDA and its legal representatives and assigns from all claims and
liability relating to said photographs/videos. Parent/Guardian Signature ___________________________________
How did you hear about SoDA?
Newspaper ___ School ___ Mail ___ Library ___ Friend (Name) ________________________ Email ___ Other ____________________