KIDS & TEENS ON-CAMERA SUMMER SESSION 2010
STUDENT INFORMATION FORM
Payment in full required to reserve a space for your child.
Classes are filled on a first come first served basis.
Enrollment is very limited. Price is $595.00 + Tax
Mail checks, (address below) in the amount of $623.04, payable
to: TAO: The Actors Ohana
To pay in cash please call us @ 808-596-8300
To pay by credit card print form then click here: Pay by Credit Card and then fill out info form below and send in.
Student’s Name:_______________________________Birthdate:_____________Age:____Sex:___
(Circle one) Kids Class -------Teen Class
Address:___________________________________________
Home Phone #:_______________________
___________________________________________
Parent/Guardian’s Name:________________________________
Phone #’s:_________________________
Parent/Guardian’s Name:________________________________
Phone #’s:_________________________
Emergency Contacts:
Name:________________________________
Phone #:__________________Relationship:_____________
Name:________________________________
Phone #:__________________Relationship:_____________
Physician’s Name:______________________________
Phone #:_______________Health Plan:_________
Physical Limitations, Allergies, Etc.:
_________________________________________________________
I/Weunderstand that promptness and attendance at all classes is necessary to achieve the personal and educational goals of the TAO program.
* I/We further understand that due to the limited enrollment, if our child is unable to attend the Summer Session for ANY reason, TAO offers NO REFUNDS for this program.
Injury/Illness Authorization
I/We authorize TAO or any of its employees to refer student, if injured or ill, to my family physician when I or my spouse/other parent cannot be reached. If a family physician is not designated, I authorize TAO or any of its employees to select a physician.
I/We understand that the TAO and its employees shall not be held responsible for property damages or injuries which may be sustained during participation in the TAO Summer Program.
Signature of Parent/Guardian:_________________________________________Date:________________
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