Form

Secret Theatre Academy (STA) Registration/ Payment Form
Semester Schedule: September 8th 2018 - January 30th 2019

Dress Rehearsal: Sat December 8 2018

Perofrmances: Sat and Sun December 15 -16 2018

Use this form for new * OR returning students to The Secret Theatre Academy!

*If you are new, please don't forget the REGISTRATION FEE of $25 per student!

This form can be used for:
- Single student taking (1-4) classes
- (2-4) siblings being registered together
This form is for tuition PAID IN FULL.**
- Early Bird Registration for (1) student for (1) class (valid till Aug 31st 2018): $480
- (1) student for (1) class: $505
- (2) classes -or- (2) siblings: $890 ($120 discount TOTAL)
- (3) classes -or- (3) siblings: $1315 ($200 discount TOTAL)
- (4) classes -or- (4) siblings: $1720 ($300 discount TOTAL)
**If in need of a payment plan, please write to classes@secrettheatre.com for more information.

PLEASE NOTE: Some class materials like costumes and dance shoes will be required purchases during semester.
STUDENT INFORMATION
Student Name *

First Name Last Name
Student Age *
Student Birthday *

/ Month / Day Year
Student E-mail (enter N/A if not applicable) *
example@example.com
Student Phone (enter N/A if not applicable) *

- Area Code Phone Number

Student Main Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Student Height (in feet. inches) *
Student T-shirt Size *

Youth small Youth medium Youth large Other (Indicate size in NOTES)
Student school *
Please indicate ALL classes being taken by FIRST student *

Junior Drama (ages 6-10): Saturday's 9:45 - 11am Senior Broadway Musical (ages 11-17): Saturday's 11 - 12:15pm Senior Drama (ages 11-16): Saturday's 12:15 - 1:30pm Junior Musical (ages 7-10): Sunday's 10 - 11:15am Senior TV/ Film Drama (ages 11-17): Sunday's 11:15 - 12:30pm Broadway Musical All-Ages (children/ teens): Tuesday's 3:40 - 4:40pm Broadway Tap All-Ages (beginners, children/ teens): Wednesday's 3:45 - 4:45pm
What is the student's experience in the performing arts? *

None; this is first class Took 1 class or was in 1 show and wanted to know more Took a few classes or was in a few shows already Other (please explain in NOTES)
MEDICAL/ BEHAVIORAL NOTES *

Asthma Allergies (indicate type in NOTES) Vision/ Hearing Problems Attention Deficit Disorder Autism Spectrum Disorder Dyslexia/ Reading Difficulties Extreme Shyness Hyperactivity Other (please explain in NOTES) N/A *
* If your child develops any medical conditions, please notify us!

NOTES

Please explain ANY extra details below, including t-shirt size, medical notes, experience level, etc.:
NOTES
IF THERE IS A SIBLING JOINING....
2nd Students Name
Age
Birthday

/ Month / Day Year
E-mail
example@example.com
Phone

- Area Code Phone Number
Height (in feet. inches)
T-shirt size

Youth small Youth medium Youth large Other (please write in NOTES)
School
Please indicate class for SECOND student

Junior Drama (ages 6-10): Saturday's 9:45 - 11am Senior Broadway Musical (ages 11-17): Saturday's 11 - 12:15pm Senior Drama (ages 11-16): Saturday's 12:15 - 1:30pm Junior Musical (ages 7-10): Sunday's 10 - 11:15am Senior TV/ Film Drama (ages 11-17): Sunday's 11:15 - 12:30pm Broadway Musical All-Ages (children/ teens): Tuesday's 3:40 - 4:40pm Broadway Tap All-Ages (beginners, children/ teens): Wednesday's 3:45 - 4:45pm
What is the student's experience in the performing arts?

None; this is first class Took 1 class or was in 1 show and wanted to know more Took a few classes or was in a few shows already Other (please explain in NOTES)
MEDICAL/ BEHAVIORAL NOTES

Asthma Allergies (indicate type in NOTES) Vision/ Hearing Problems Attention Deficit Disorder Autism Spectrum Disorder Dyslexia/ Reading Difficulties Extreme Shyness Hyperactivity Other (please explain in NOTES) N/A *
* If your child develops any medical conditions, please notify us!

NOTES

Please explain ANY extra details below, including t-shirt size, medical notes, experience level, etc.:
NOTES
GUARDIAN INFORMATION
Guardian Name (primary) *

First Name Last Name
E-mail *
Cellphone Number *
Second Phone Number (enter N/A if not applicable) *
Guardian Name (enter N/A if not applicable) *

First Name Last Name
E-mail (enter N/A if not applicable) *
Cellphone Number (enter N/A if not applicable) *
Second Phone Number (enter N/A if not applicable) *
APAYMENT INFORMATION AA AAAAA

Make Payment HERE *

NEW STUDENT Registration Fee: $25 per student $ 25.00

How many new students?

Early Bird Registration for (1) Student -or- (1) Class for F/W 2018 (valid till August 31st 11:59pm) $ 480.00

(1) Student -or- (1) Class for F/W 2018 $ 505.00

(2) Students -OR- (2) Classes for F/W 2018 ($120 discount TOTAL) $ 890.00

(3) Students -OR- (3) Classes for F/W 2018 ($200 discount TOTAL) $ 1,315.00

(4) Students -OR- (4) Classes for F/W 2018 ($300 discount TOTAL) $ 1,720.00

Enter coupon

Total $ 0.00

-Terms of Service

Your class fees are a non-refundable fee. We will only consider refunds for medical reasons or other urgent situations. If you wish to seek a refund under such conditions you must apply in writing or in person to the Academy.

By registering for programs at STADA, I agree:

to follow all policies and procedures of the facility;

that there are risks and benefits of physical activity and state that your child is in condition to play;

to allow photos and likenesses of my child to be used for publicity purposes for STADA
aSURVEY a aaaaaaaaaaaaaaaaaaaaaaaa
How did you hear about our school? You may pick more than one *

Friend who is already enrolled/ previously enrolled Newspaper ad ** Online ad ** Postcard or poster ** Other source **
** Specify what newspaper, website, neighborhood of poster, "Other source".... or write N/A if heard about through friend *
Enter the message as it's shown *
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