Name of Participant *

First Name

Last Name

Which group would you prefer to be in? *

Please pick all that apply

Group #1 - Wednesday afternoons + Sundays

Group # 2 - Monday nights + Sundays

Both

Are you available for shows from May 29th to June 7th? *

Yes

No

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone Number *

(###)

###

####

Please read the terms below and check the box to agree. *

I am aware and familiar with what I have signed up for. I acknowledge that there is a risk of injury when receiving instruction and at the times when I am without instruction. In consideration of the facility and location provided to me, I forever release, discharge, and hold harmless Globus Theatre and any of its employees, representatives, or members from all liability or claim. Medical Emergency: I consent for any employee or representative of Globus Theatre to seek reasonable medical treatment, emergency or otherwise, at any time for me. I agree to be liable for the cost of such treatment. Additional Waiver: I hereby grant Globus Theatre permission to lawfully photograph and/or videotape myself for educational or marketing purposes.

I understand and agree with all the above terms.