Clone of Murdock 1 & 2 - The Share Bears 2026

Be sure to click "submit" at the bottom, especially if you are using an alternate payment method. If you do not receive a confirmation, I did not receive the form.

Child's Name (First and Last)

Child's Grade and Teacher (Skip if not know at this time)

Child's regular dismissal following Drama Club: Car OR ASP (Pick one. If this changes at any time, please let us know)

Name of Adult 1

Email of Adult 1

Phone of Adult 1

Name of Adult 2

Email of Adult 2

Phone of Adult 2

Mailing address

Emergency contact (name and phone number of someone other than parents/guardians)

Costume information (size in numbers and letters for costumes and cast shirt)

List any allergies or special needs: Help us get to know your child

I hereby give permission for images of my child, captured during Drama Club through video, photo and digital camera, to be used solely for the purposes of Little Actors’ Studio promotional material and publications, and waive any rights of compensation or ownership thereto.

Signature

I grant my authorization and consent for Amber Lopez or other adult employed by Little Actors' Studio (hereafter “Designated Adults”) to administer general first aid treatment for any minor injuries or illnesses experienced by my child. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designated Adults to summon professional emergency personnel to attend, transport, and treat the minor. I agree to assume financial responsibility for all expenses of such care.

Signature

I grant my authorization and consent for Amber Lopez or other adult employed by Little Actors' Studio (hereafter “Designated Adults”) to administer general first aid treatment for any minor injuries or illnesses experienced by my child. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designated Adults to summon professional emergency personnel to attend, transport, and treat the minor. I agree to assume financial responsibility for all expenses of such care.

I have read and understand the above statements.

Signature

BE SURE TO HIT SUBMIT, ESPECIALLY IF YOU ARE USING AN ALTERNATE PAYMENT METHOD OTHER THAN A CREDIT CARD AT THIS TIME. YOU WILL RECEIVE A CONFIRMATION PAGE. IF YOU DO NOT RECEIVE A CONFIRMATION PAGE, I DID NOT RECEIVE THE FORM.

*You may pay using a credit card through Stripe and using the check boxes below. Do not check a box unless you plan to pay with a credit card.

*You may pay via Venmo (@amber-lopez-mieres) and take advantage of the Teacher/Sibling discount.

$330.00/full year
$168/semester

*You may also pay via cash or check and take advantage of the Teacher/Sibling discount.

$330.00/full year
$168/semester

*You may make 8 monthly payments of $45/month. Contact Ms. Amber to make arrangements for monthly payments.

*You may pay via Zelle using 770-374-5851 and take advantage of the Teacher/Sibling discount.

$330.00/full year
$165/semester

Credit Card Payment

Full Year 26-27$345.00

Your child will be enrolled for the entire year.

Fall 2026 Semester$178.00

Your child will be registered for Fall 2026 You must make another payment before January 15, 2027 at which time your child will automatically be registered for ARF in the Spring.

Full Year 26-27 Teacher/Sibling Discount$330.00

Your child will be enrolled for the entire year. You must make another payment before January 15, 2027.

Fall 2026 Teacher/Sibling Discount$168.00

This reflects a discount. Your child will automatically be registered for Spring 2026. You must make another payment before January 15, 2027.

Total $0.00

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