KISMET KIDS MUSICAL THEATRE

Select Summer Camp Session 1, Session 2, Or Both:

Student Name

First NameLast Name

Grade

Student Date of Birth

Student T-Shirt Size

Address 1

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Parent 1 Name

First NameLast Name

Parent 1 Email

example@example.com

Parent 1 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent 2 Name

First NameLast Name

Parent 2 Email

example@example.com

Parent 2 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

If parent(s) cannot be reached, emergency contact:

Emergency Contact 1 Name

First NameLast Name

Emergency Contact 1 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact 2 Name

First NameLast Name

Emergency Contact 2 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

List any conditions which should be known by physician administering treatment:

The fee includes registration, script, costume rental, program t-shirt, and classes in musical theatre, acting, dance and vocal technique. A $125.00 non-refundable deposit (per child) must be paid in advance to reserve your child's space in the program. This deposit will be applied toward your tuition. The balance of the session ($300.00) is due on or before 12/1/26, or may be paid in three installments of $100 on 12/1/26, 1/1/27, and 2/1/27. Fees paid after these dates will be subject to a 10% late fee. Deposit fees are non-refundable.

Release of Liability: In the event of an accident, injury, or illness of the above named participant, consent is hereby given to any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general supervision of any physician and surgeon licensed under the provisions of the medicine practice act of the medical staff or employed by the director of emergency department of the hospital. I release Kismet Kids Musical Theatre and their elected representatives and employees from any and all claims, demands, liability, or loss which may arise as a result of participation in the selected activity. I absolve and release/hold harmless Kismet Kids Musical Theatre, and their employees and contract instructors from any liability which may result from my participation or that from any minor in my legal custody, in the selected activity. If the participant is a minor, I also give my permission for his/her participation at Kismet Kids Musical Theatre and for any necessary medical treatment. Permission is granted for the use of any publicity photos or videos taken of all participants during the workshop and performances.

Today's Date

Date

Electronic Signature:

Please sign your name

Please select your perferred payment method below.

Payment Options:

** Instructions will be provided upon receipt of registration **

Online Payment:

Online Registration DEPOSIT Only

**** Please Note **** Registration deposit is $125. ALL ONLINE PURCHASES HAVE AN ADDITIONAL TRANSACTION FEE ADDED TO TOTAL.

$129.04

Online Registration FULL PAYMENT

**** Please Note **** Registration payment in full is $425. ALL ONLINE PURCHASES HAVE AN ADDITIONAL TRANSACTION FEE ADDED TO TOTAL.

$438.00

Total

Credit Card

Participating in, and/or attending Kismet Kids Musical Theatre (KKMT) camp or an event at KKMT automatically begins the Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 set forth herein. Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. KKMT has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you, your children, or family members will not become infected with COVID-19. Furthermore, participating in, and/or attending events could increase your risk of contracting COVID-19. By participating in, and/or attending events, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk of me or my children being exposed to, or infected by, COVID-19. I understand that the risk of becoming exposed to or infected by COVID-19 at the camp may result from the actions, omissions, or negligence of other attendees, and others, including, but not limited to, employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection our attendance at the event or participation in any programming at KKMT. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Kismet Kids Musical Theatre, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of KKMT, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any event or program at with KKMT.

When receiving the online invoice, do you want to pay the deposit or pay in full?

Willy Wonka Registration

Online Payment:

Credit Card