SCT Class Registration Form- Children & Young Adults

Please fill out the form below and drop off at the SCT Playhouse: 518 1^st Ave. E , or mail to:

P.O. Box 1225 , Spencer , IA   51301 .  Payment for the class is required at the time of registration.

General SCT Class Policies:

• We will contact you to confirm enrollment upon receiving your registration. 
• Any requests for changes or refunds must be made one week prior to the first class meeting.  You will receive a full refund minus a $10 processing fee.  No refunds after the first class meeting, but a credit can be made toward tuition of a future class within a year of the cancellation. 
• Registration is ongoing up to the first day of class or until class is full. 
• A limited amount of need-based scholarships are available.  Applications must be submitted by June 8, 2009.  Applications available at SCT Playhouse.
• SCT Playhouse, local newspapers, and TV stations will occasionally document or feature Playhouse classes in film and news stories.  If you do not want your child photographed, please notify the SCT Playhouse in writing.

Participant Information

Student Name:                                                                                                                         

Date of Birth:                                                       Age:                                                              

Grade in fall 2009:                                 School:                                                                        

Parent/ Guardian Name:                                                                                                            

Address:                                                                                                                                  

City/ State/ Zip:                                                                                                                                    

Email Address:                                                                                                                         

Home Phone:                                                      Work/ Cell Phone:                                           

Is parent/ guardian a Season Ticket Holder or Contributing Member?        YES            NO

Name of Holder/ Contributing Member:                                                                                       

Emergency Name & Phone:                                                                                                       

How did you hear about SCT Children’s Theatre Classes?                                                           

Class Information & Payment

Class(es)/ Camps Selected:

1.                                                                                                                                            

2.                                                                                                                                            

3.                                                                                                                                            

Cost of Class(es):                                                                                                                    

Total Amount:                                        Check #                                    Cash                            

Season Ticket Holders and Contributing Members receive 10% Discount. Member discount is already figured into the cost of the camp

Add $5 donation to SCT Children’s Theatre Scholarship Fund?      YES                 NO

MC/ Visa Account Number (if not paying by check or cash):                                                         

Exp. Date (Month/Year):                                                                                                           

Name on Card:                                                                                                                         

SCT Playhouse Health/ Consent Form

Must be completed for all participants.  Please print clearly.

Student’s Name:                                                                                                                     

Parent/ Guardian Name & Phone:                                                                                          

Emergency Contact (other than parent or guardian):                                                 

Phone:                                                             Relationship:                                                  

Physician’s Name:                                                                                                                 

Physician’s Phone:                                                                                                                 
Please note any allergies, physical or health conditions of which we need to be aware:                                                                                                                                                                                                                                                                                                

Current medications:                                                                                                              

Please note any special needs of your child:                                                                                                                                                                                                             

AUTHORIZATION FOR TREATMENT:  By entering my name below, I hereby give my permission to the medical personnel selected by the SCT Playhouse staff to give medical attention to and necessary transportation for the child named above.  In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the SCT Playhouse staff to secure and administer treatment, including hospitalization, for the child named above. 

Parent/ Guardian Signature:                                                                                                   

Date: