Spring Theater Registration

2024 Production Registration
Youth Information
Youth's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Cell Number*
E-mail*
[email protected]
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.

Production Registration

Spring 2024 ProductionFall 2024 ProductionBoth Productions

Photo Release/Social Media Waiver
I hereby give my approval for my child’s photograph to be taken and used on website/social media promotions by Mooreland Productions during the selected production.*

YesNo
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Mooreland Productions during the selected production. In exchange for the acceptance of said child’s participation by Mooreland Productions, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Mooreland Productions and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected production(s).
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

Clear

Payment

Spring 2024 Production If registering more than one child or class, please email for discount code.

$149.00

Fall 2024 Production If registering more than one child or class, please email for discount code.

$149.00 Quantity

Deposit for Production Please contact [email protected] to set up a payment plan for the balance.

$50.00

Total

$0.00

2024 Production Registration