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Student
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*Denotes Required
(If not applicable, please type n/a)
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Students Name*:
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Age*:
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Sex*:
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Address*:
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City*:
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State*:
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Zip*:
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Telephone*:
(555) 555-1212
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Email*:
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Grade Entering Fall*:
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Birth date*:
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Cell Phone:
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Mother
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Mother's Name*:
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Employer:
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Email:
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Cell Phone:
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Business Phone:
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Father
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Father's Name*:
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Employer:
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Email:
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Business Phone:
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Cell Phone:
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Medical/Special
Needs
Out-of-town students, please list any allergies or special requirements
needed when being placed with a host family*: (If not applicable, please type n/a)
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Other
Information
Host Family
Student applicants, please list household pets, rooming capabilities,
siblings and their ages, and any other information that might be useful in
placing students with you*:
(If not applicable, please type n/a)
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TUITION
Fees will cover the full cost of instruction, field trips, and theatre
tickets. They will vary according to whether food and lodging is
provided as follows:
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Out-of-town
student - hosted by local family:
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$800
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Local
student (commuter) providing own food and lodging:
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$600
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Local
student hosting one out-of-town student:
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$400
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Local
student hosting two or more out-of-town students:
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$350
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A non refundable deposit of ($350.00) must accompany each application. The full tuition balance is due Friday, June 25th, 2010. The full tuition amount ($400.00) for those hosting 1 out-of-town student; ($350.00) for those hosting 2+ out-of-town students must accompany the application.
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PAYMENT
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Please
chose category:
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___Out-of
town ($800)
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___Local
Commuter ($600)
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___Host
1 Family ($400)
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___Host
2+ Family ($350)
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Tuition*:
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$50
Late Fee (due on applications after June 25):
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TOTAL AMOUNT DUE*
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Nonrefundable deposit
accompanying application (Deposit required with application)
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350.00
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Balance due by June 25th, 2010*:
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I wish to pay by*:
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___Visa ___MC
___AMEX
___DISC ___Check ___Cash
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Credit Card Number*:
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Expiration Date*:
00/00
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If accepted,
I will abide by CATS rules and regulations. I will respect the
Director's authority during my stay.
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Student's
Signature:
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TO
THE PARENTS: Please read and sign this agreement: I give permission for my child,
if accepted, to participate in any and all activities and for the
information related to my child's performance in respect to the CATS
program to be used for research and publication purposes. I will not
hold the Creative Arts Theatre & School, any individual staff member,
or any directors responsible for any accidents incurred during the 2010
session. I understand that I will be financially responsible for any
damages to property resulting from any actions of my child. Any
disciplinary problems will be handled on an individual basis. Very
serious problems may result in dismissal. There are no refunds or
cancellations.
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Parent's
Signature*:
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