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Shakespeare Superheroes 2011

Enrollment Form
Cobb Resident
Name: / Date of Birth:
Address: / Apt #: / County:
Parent/Guardian Name(s): / Email:
Phone: Daytime: / Evening:
School you will attend in fall / Grade (Fall ’11):

Please check the session(s) you are applying for: the plays are A Midsummer Night’s Dreamand Romeo and Juliet in both sessions!

oJune 6th to June 17th / oJuly 18th to 29th

Carpooling list: may we add you to a list of names and phone numbers of participants that would like to carpool? This list will be distributed to any session participants that want to arrange carpooling

YesNo

On behalf of ______, of whom I am parent/guardian, I agree to indemnify and hold harmless, the Atlanta Shakespeare Company at the New American Shakespeare Tavern (ASC) its executive officers, Board of Directors, agents, employees, faculty and associates from any and all losses, damage suits, claims, costs, medical or other related expenses, demands, judgments or liabilities, whatsoever, arising out of, or in any way connected with, ASC’s Shakespeare Superheroes 2011 program, particularly regarding any physical injury incurred as a result of participation in the program, or as a result of the above named program, and from any resulting medical expenses. Further more, on behalf of ______, of whom I am parent/guardian, I grant permission for him/her to be included in any audio/video tape and/or photographs made of his/her participation in the above mentioned program, and further grant ASC permission to use such video/audio tape and/or photos for any education research or promotion of ASC programs.

Parent/Guardian signature ______Date______

Tuition: $475 per student, per session$25 off if enrolled by April 1st

Total Amount $______total # of students enrolled ______

I am paying by check$------

I am paying by credit card$------(please call our box office to pay by Credit Card)

Full payment must be received by May 3rd, (or April 1st for discounts to apply). Students are not considered enrolled

in the program unless a completed form and the full tuition are received. Email enrollment must be matched with

credit card payment information or check to be confirmed.

Refund Policy: Total refund, minus non-refundable $25 application fee per child, is available if participant notifies Atlanta Shakespeare

in writing more than four full weeks before the start date of the session. A 50% refund, minus non-refundable $25 application fee per

child is available if participant notifies Atlanta Shakespeare in writing more than two full weeks before the start date of the session.

No refunds will be given when canceling within two full weeks of the start date of the session.