Children registration

Please fill out the form for each child registering for a program. Thanks!

* Indicates required field

Registration for: *

Fall 2019 Physical Theater Workshop - $90

Parent/Guardian's Name *

First

Last

Phone Number *

Child's Name *

First

Last

Email *

Additional Info. I need to know about your child (i.e. allergies, medical needs, etc.) *

Comments *

Age *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Your payment is refundable 3 weeks before the start of the workshop/camp/class. After 3 weeks there can be no refund. There is a $25 admin. fee for refunds. If the program is cancelled your deposit will be refunded in full.

I hereby understand and acknowledge that the camps/classes/workshops held by "Muck and Gold LLC" may expose my child to many inherent risks, including accidents, injury and illness and that I assume all risk associated with participation and (ii) I agree, for myself and anyone entitled to act on my behalf, to hold harmless, waive and release Muck and Gold and its agents and representatives from responsibility, liabilities, demands, or claims of any kind arising out of my child's participation in Muck and Gold camps/classes/workshops.

Check box *

I agree

I give permission for my child to participate in all workshop/class/camp activities, including field trips outside of camp. *

Yes No

I give permission to Muck and Gold to use photos and videos taken in a workshop/class/camp to use in our flyers, advertisements and social media. *

Yes No

Submit