Keith Mottola
Artistic Director
Steps Off Broadway Productions Incorporated
Name: ___________________________________________________________________________________________________
Address: _________________________________________________________________________________________________
City:
_____________________________________________________ State______________ Zip Code_____________________
Phone
#: ________________________________________________
Parent’s
Name____________________________________________________________________________________________
Daytime Contact #: _____________________________________ Evening Contact #: __________________________________
E-mail Address: ______________________________________________________
Name
of Emergency
Contact: ________________________________________________________________________________
Phone #: ____________________________________________________________
Amount of Payment: $________________ (MINIMUM DEPOSIT IS $99.00)
EARLY PROGRAM REGISTRATION FEE IS $450 UNTIL MARCH 31, 2008. ALL REGISTRATIONS RECEIVED AFTER MARCH 31, 2008 WILL BE SUBJECT TO THE REGULAR REGISTRATION FEE OF $600.00
Method of Payment: (circle one)
CHECK VISA MASTERCARD AMERICAN EXPRESS DISCOVER
Card
#:__________________________________________________________________ Expiration Date: __________________
Does the Participant have any food or beverage allergies, or medical problems that would effect their participation in this program? If so, explain below.
_____________________________________________________________________________________________________________
What area of performance is the Participant interested in? (Circle each area of interest)
THEATRE DANCE VOICE TECHNICAL
I, THE UNDERSIGNED, DO HEREBY VOLUNTARILY SUBMIT MY APPLICATION TO STEPS OFF BROADWAY PRODUCTIONS INCORPORATED FOR REGISTRATION FOR THE 2008 SUMMER PROGRAM. I UNDERSTAND THAT THIS IS A BINDING CONTRACT AND COMMITMENT TO PAY THE FULL AMOUNT AGREED UPON AS EXPLAINED, ON TIME FOR THE 2008 SUMMER PROGRAM I HAVE SIGNED UP FOR. I ALSO UNDERSTAND THAT AS THE UNDERSIGNED, IF THE PARTICIPANT SIGNED UP ON THIS CONTRACT CHOOSES NOT TO COMPLETE OR CONTINUE SERVICES RELATED TO THIS CONTRACT THAT THERE ARE NO REFUNDS AFTER MAY 1, 2008. IT IS UNDERSTOOD THAT THIS IS SUBJECT TO A NON-REFUNDABLE DEPOSIT OF $99.00. I ALSO UNDERSTAND AND AGREE TO COMPLY WITH ALL OF THE SCHEDULES, AGREEMENTS, RULES, TERMS, WAIVERS AND POLICIES POSTED and available upon request, AT STEPS OFF BROADWAY PRODUCTIONS INCORPORATED.
SIGN_____________________________________________________________________________ DATE ______/______/______
(SIGNATURE OF APPLICANT OR PARENT/LEGAL GUARDIAN IF APPLICANT IS UNDER THE AGE OF EIGHTEEN)
NOTE: Balance of Summer Program Fee is due by May 1, 2008.
ATTENTION-DEPOSIT IS NONREFUNDABLE FOR THE 2008 SUMMER PROGRAM LISTED-ATTENTION
Send To: Steps Off Broadway Productions Incorporated
799 S. Main St. #18
Bellingham, MA 02019