Name: Jr Players Registration
SKU: 22012
Availability: InStock

This registration form is for Jr. Players only (Ages 3-7*). If you are also registering children for the Main Cast (Ages 8-14) you must complete that registration form separately.

Please review Jr Players overview for more information.

*If space permits conditional exceptions may be made for younger children.

Jr. Players Registration

Full payment is required to complete this registration form. If you need to work out a payment plan or other financial arrangement, please contact us before registering.

Price:

Child's Information

Child's Name*

First Last

Age*

Birthdate*

Current Grade*

Additional Siblings

Are you registering additional siblings?*

How many additional siblings are being registered?*

1
2

Sibling #1

Sibling #1 Name*

First Last

Sibling #1 Age*

Sibling #1 Birthdate*

Sibling #1 Grade*

Sibling #2

Sibling #2 Name*

First Last

Sibling #2 Age*

Sibling #2 Birthdate*

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?

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.

Click the "Add to cart" button below to continue the registration process. Your registration is not complete until you have gone through the checkout process and completed payment!

Jr Players Registration

Child's Information

Additional Siblings

Sibling #1

Sibling #2

Parent/Guardian Contact Information

Parent/Guardian #2 Contact Information

Emergency Contact Information

About Your Child(ren)

Legalese

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