About Broadway-West

2013 Registration

Participant Information

First Name *

Last Name *

Birthday *

Gender

Male Female

E-mail *

Phone *

Street Address

City

State

Zip

School

T-Shirt Size*

YXS YS YM YL S M L XL 2XL

Participant's Allergy or Medical Conditions

Emergency Contact

First Name *

Last Name *

Phone *

Parent / Guardian's Information (if under 18)

First Name

Last Name

RELEASE OF LIABILITY*

By submitting this form I confirm that I have read this Release of Liability and that I agree that as the parent / guardian, I submit that the participant is in good health and I give my permission for him/her to participate in this program. I hereby release, hold harmless, discharge and agree not to sue Broadway West, its directors, employees, volunteers, sponsors, owners/leasers of the premises for all liability from participation in these and any other related activities. I also understand Broadway west retains the right to use for publicity and advertising, photographs and videos taken of participants. I have read Broadway West's Release of Liability and Payment/Cancellation Policy.

Payment and Cancellation Policy*

By checking this box and submitting this form, I confirm that I have read and understand the following Payment and Cancellation Policy. Fees are due at the time of registration by either cash or check. Participants who wish to withdraw due to scheduling or any other reason may do so at any time through written cancellation but are not guaranteed a full refund. No refunds will be given if participant withdraws three weeks before the camp start date.

Parent/Guardian or Participant Signature(must be over 18) *

Verification:

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Have questions?
e: britta@skoomsclass.com