Teen Sketch Comedy Registration 2019-2020

Please use this form to register online for Teen Comedy Club.  If you have any questions, please call us at 603-431-6644, or email info@nhtheatreproject.org. 

NOTE: REFUNDS WILL NOT BE ISSUED AFTER CLASSES HAVE STARTED.

Student Information
*First Name
*Last Name
*Address 1
*City
*State
*Zip
*Phone
*Email
*Student's Age
*Student's Date of Birth
*Primary Parent/Guardian Contact
Primary Contact's Address, if different from student
*Email Address
*Cell # or Work #
*Secondary Parent/Guardian Contact
Secondary Contact's Address, if different from student
*Email Address
*Cell # or Work #
*Student is in
Middle School
High School
*Please indicate which trimester(s) you are registering for:
Spring - *ONLINE CLUB* April 7th through May 26th! ($320)
PARENT/GUARDIAN CONSENT FOR TREATMENT OF A MINOR
Emergency Contact Information in Case of Medical Emergency
*Emergency Contact (if other than parent/guardian) - The emergency contact person should have authority to make emergency decisions for the student, to drop off and pick up the student from NHTP, and to otherwise have contact with the student.
*Emergency Phone Number
*Relationship to Student
*Are all immunizations required to attend public schools up-to-date?
Yes
No
List any allergies including food, bee sting, or other
Please indicate appropriate treatment
List any conditions which may limit student's participation or which the NHTP Staff should be made aware of
Anything else you would like the staff to know about your child
*Permission for reproduction of photographic/video images. Please sign and date this registration. An electronic signature for this form is acceptable.

The parent or legal guardian acting on behalf of the minor grants New Hampshire Theatre Project (“NHTP”) the right to reproduce the videography and photographic images of the above named minor.

This authorization is intended to grant to NHTP the irrevocable right to use such photographs and video for reproduction in any medium including but not limited to print and electronic (e.g. Internet). I understand that the images(s) may be used, without compensation to me, in promotional materials for NHTP, including, without limitation, brochures, posters, and web display. I hereby waive any and all rights I may have to inspect or approve any of the finished or unfinished photographs, videotapes or other means of reproduction referred to herein, so long as the use is for a lawful purpose.

I release, discharge, and agree to hold harmless and defend NHTP and all persons acting under NHTP's authority from any liability in connection with the making and use of such photographic or video images, including without limitation any claims for violation of any right of publicity or privacy. I hereby warrant that I have read the above authorization prior to its execution, and I am fully familiar with the contents of it. This authorization shall be binding upon me and my heirs, legal representatives, and assigns.

*How would you prefer to receive mailings from NHTP? Please check the box that applies.
Email Only
Snail Mail Only
Both Email and Snail Mail
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