Innovation Drama Academy TERM 1 REGISTRATION

Innovation Drama Academy Class Registration Form
Registration and Medical Waiver
Parent/Guardian Email:*
example@example.com
Parent/Guardian Name*
First NameLast Name
Student Name*
First NameLast Name
Which Class is your student enrolling in?*
Acting Level 1 TUESDAYS 5:30-6:30PM (Sept. 15th-Nov. 3rd)Acting Level 2 TUESDAYS 6:45PM-7:45PM (Sept. 15th-Nov. 3rd)Dance in the Style of Musical Theatre LEVEL 1 THURSDAYS 5:00-6:15PMDance in the Style of Musical Theatre LEVEL 2 THURSDAYS 6:30-7:45PM
Student's age at time of registration *
Student's Grade for the 2020-2021 School Year*
Student's School for the 2020-2021 School Year*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Parent/Guardian Phone Number*
Area CodePhone Number
Emergency Contact Name*
First NameLast Name
Emergency Contact Number*
Area CodePhone Number
COVID-19 INFORMATION
Ensuring the health and safety of our students and staff is a top priority. All students are expected to behave in a manner that supports social distancing and general safety.
Face masks are required for all students and staff. High-use surface areas and restrooms will be cleaned throughout the day and thoroughly disinfected each night. Activities are modified to adhere to social distancing guidelines.
KEEPING IDA SAFE
Staff & Students will be asked to wear a mask indoors. Students will be asked to sanitize and/or wash hands every 30 minutes at minimum.
Staff will clean general use supplies throughout the day and sanitize nightly.
Tables & chairs will be cleaned throughout the day and sanitized nightly.
I agree and understand that in order to comply with the state and local agencies my child(ren) will not be in attendance of class if showing any signs or symptoms of COVID-19 or been exposed to someone with COVID-19 (below) will be asked to withdraw from Innovation Drama Academy Class. A doctor’s release and 14-day self-quarantine are required upon re-entry to our programs.
Cough
Shortness of breath or difficulty breathing
Fever
Chills
Muscle Pain
Sore Throat
New loss of taste or smell
This is a list of possible symptoms. Other less common symptoms have been reported, including gastrointestinal symptoms like nausea, vomiting, or diarrhea.
Finally, this agreement indicates that I release, hold harmless, and exonerate Innovation Drama Academy from any liability that may occur during the use of Innovation Drama Academy classess dismissal after the duration of the registrants class time.
Have you read the waiver above and agree with all its terms and conditions?*
I agree
MEDICAL WAIVER
By signing this waiver, I, the legal guardian of the student(s) I have registered for Innovation Drama Academy Class, agree to the following conditions:
I authorize Innovation Drama Academy to contact the persons named as parents or emergency contacts and to authorize the named physician to render such treatment to my child as deemed necessary. I assume full financial responsibility for emergency medical care for the participant while he/she is enrolled in Innovation Drama Academy Classes.
Further, this signed statement certifies that my child is medically cleared to participate in the Innovation Drama Academy Classes and to participate in all activities as described in the camp descriptions while he/she is enrolled in class.
Clicking the box below confirms that you have read the medical waiver, that you understand it, and that you agree to be bound by it.*
I agree
Name of Parent/Guardian that agrees and adhere to medical waiver*
First NameLast Name

Health History*

	No	Yes	Please Explain.
Does your child have any restrictions on activity?		2
Will your child need any special assistance while in class?		4
Is there there anything else you feel we should know health wise about your child? Please list any other medical information the instructors should have about your child.		6

Medical Questions *
No Yes If yes, please explain.
Does your student have any allergies? 8
Does your student require an EpiPen? 10
Does your student have any dietary restrictions? 12
May over-the-counter medications be given to your child while in class? *
No Yes
Acetaminophen (Tylenol)
ASA (Aspirin)
Ibuprofen (Advil)
Antihistamines (Benadryl, Diphenhydramine)
Sunscreen
IDA Summer Classes TERM 1 Sept. 15th - Nov. 3rd 2020
prevnext( X )
IDA Acting Level 1 TUESDAYS 5:30-6:30PM***Please make payment via VENMO to: @Bridget-Burrows-3. When making payment in description please note the student's name.
$150.00

IDA Acting Level 2 TUESDAYS 6:45-7:45PM***Please make payment via VENMO to: @Bridget-Burrows-3. When making payment in description please note student's name.
$150.00

IDA Dance in the Style of Musical Theatre Level 1 THURSDAYS 5-6:15PM***Please make payment via VENMO to: @Bridget-Burrows-3. When making payment in description please note student's name.
$150.00

Dance in the Style of Musical Theatre LEVEL 2 THURSDAYS 6:30-7:45PM***Please make payment via VENMO to: @Bridget-Burrows-3. When making payment in description please note student's name.
$150.00

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Total
$0.00
Should be Empty:

	No	Yes	If yes, please explain.
Does your student have any allergies?		8
Does your student require an EpiPen?		10
Does your student have any dietary restrictions?		12

	No	Yes
Acetaminophen (Tylenol)
ASA (Aspirin)
Ibuprofen (Advil)
Antihistamines (Benadryl, Diphenhydramine)
Sunscreen

Enter coupon

Innovation Drama Academy Class Registration Form