Workshop Registration - Spotlight Kids NY

Student Name*

First Last

Phone*

Age*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Grade*

Choose Your Workshop*

Please Choose A Workshop

Friday Craft Workshop*

Please Choose A Friday Workshop

Friday Theater Night: Parents Night Out! Workshop*

Please Choose A Friday Workshop

Saturday Theater Night: Parents Night Out! Workshop*

Please Choose A Saturday Workshop

Emergency Info

Parent Name*

First Last

Parent Phone*

Email

Allergies/ Medical Conditions or other concerns:*

Does Your Child Have An Epi-Pen?*

Yes
No

Is there anything you would like us to know about your child?

Photo/Video Release

I give permission to take my child’s picture and/or video for classroom projects and/or events.*

Yes
No

I certify that the enrollee has no condition that prohibits full participation in the activities at Spotlight Kids NY. I assume all ordinary risks when the enrollee is using the facilities and hereby release Spotlight Kids NY, or any of its staff or teachers, for any injury or damage suffered in connection with classes or facilities, including lost or stolen items.*

Yes
No

Signature*

Workshop Price*

Price: $60.00

Workshops

Emergency Info

Photo/Video Release