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Programs
Main Cast (ages 8-14)
Junior Players (ages 3-7)
Teen Mentorship Program
Productions
The Annex
About LPRT
About
Staff
Contact
Donate
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/ Jr Players Club – Puppet Play!
Jr Players Club – Puppet Play!
5 in stock
Jr. Players Club - Puppet Play! Registration
Full payment is required to complete this registration form.
Price:
$100.00
Child's Information
Child's Name
*
First
Last
Age
*
Birthdate
*
Date Format: MM slash DD slash YYYY
Current Grade
*
Additional Siblings
Are you registering additional siblings?
No
Yes
How many additional siblings are being registered?
*
1
2
Sibling #1
Sibling #1 Name
*
First
Last
Sibling #1 Age
*
Sibling #1 Birthdate
*
Date Format: MM slash DD slash YYYY
Sibling #1 Grade
*
Sibling #2
Sibling #2 Name
*
First
Last
Sibling #2 Age
*
Sibling #2 Birthdate
*
Date Format: MM slash DD slash YYYY
Sibling #2 Grade
*
Parent/Guardian Contact Information
Parent/Guardian Name
*
First
Last
Relationship to Child(ren)
*
Address
*
Street Address
City
ZIP Code
Primary Phone Number
*
Secondary Phone Number
Email
*
Enter Email
Confirm Email
Would you like to add details for another parent/guardian?
No
Yes
Parent/Guardian #2 Contact Information
Parent/Guardian #2 Name
*
First
Last
Parent/Guardian #2 Relationship to Child(ren)
*
Parent/Guardian #2 Address
*
Street Address
City
ZIP Code
Parent/Guardian #2 Primary Phone Number
*
Parent/Guardian #2 Secondary Phone Number
Parent/Guardian #2 Email
*
Enter Email
Confirm Email
Emergency Contact Information
In case of emergency, if we can’t reach you, whom do we call?
Emergency Contact Name
Emergency Contact Phone
Child’s Physician
Physician's Phone Number
About Your Child(ren)
Special Considerations
Does your child have any physical problems, special medications, dietary restrictions, limitations of activity, or other considerations of which the staff should be aware? Please specify:
Legalese
Release
*
I, the undersigned, being a parent/guardian of the above, or being an active participant in Little People’s Repertory Theatre, a program operated by the San Lorenzo Valley Youth Council, Inc., do hereby agree to hold harmless for injury, loss or damage the San Lorenzo Valley Youth Council, Inc. and any or all of its employees, and any or all individuals being paid or volunteering their services connected with San Lorenzo Valley Youth Council, Inc. programs. I also give employees of the San Lorenzo Valley Youth Council, Inc. the right to authorize emergency treatment and/or ambulance service for the above, if deemed necessary by the employee.
Model Release
*
I grant permission to Little People's Repertory Theatre to use photographs of my child(ren) taken during rehearsal and performances for publication in LPRT promotional materials, including the internet.
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