CSEE Summer Camp Registration

Registration Date *

CSEE Performing Arts Fall Semester Classes

Classes (Monday thru Thursday, 8:00AM to 2:30PM

1st STUDENT'S INFORMATION

Student1 Name *

Date of Birth *

Sex *

Male

Female

Registration & Class Fee

Student #1 Payment in Full - weekly $250

2nd STUDENT's INFORMATION

Student2 Name

Date of Birth

Sex

Male

Female

Registration & Class Fee

Student #2 Payment in Full - weekly $250

3rd STUDENT'S INFORMATION

Sex

Male

Female

Student3 Name

Date of Birth

Registration & Class Fee

Student #3 Payment in Full - weekly $250

4th STUDENT'S INFORMATION

Student4 Name

Date of Birth

Sex

Male

Female

Registration & Class Fee

Student #4 Payment in Full - weekly $250

5th STUDENT'S INFORMATION

Student5 Name

Date of Birth

Sex

Male

Female

Registration & Class Fee

Student #5 Payment in Full - weekly $250

PARENT / GUARDIAN INFORMATION

Parent / Guardian Name *

Relationship to Student *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Set & Confirm New Member Password *

Confirm Set & Confirm New Member Password *

Total Tuition (No Registration Fees)

PHOTO RELEASE FORM

I hereby grant Youth Theatre Interactions INC. (YTI) my permission to use the photographs or video of myself or my child(ren) for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. No royalty fee or other compensation shall be paid for such use.

Parent / Guardian Signature *

Clear

Date *

RELEASE OF RESPONSIBILITY

In giving my consent, I further release YOUTH THEATRE INTERACTIONS, INC. (YTI) and its administrators, instructors, or any person acting on behalf of YTI of any responsibility for accident or injury as a result of participating in this virtual instructional program.

Parent / Guardian Signature *

Clear

Date *

COMPLETE YOUR REGISTRATION…Secure your child(ren) participation

I have received, read, and understood the YTI Registration Form. Your registration is not complete until you submit your registration fee payment. Please click submit below, then you will be redirected to a secure payment page through PayPal. To make your payment, you may use any major credit or debit card. Once your payment has processed, your registration will be complete. If you are deferring first payment until 7/22/22 please complete this form but then cancel out of PayPal and call the office at 914-963-3040.

Payment Options

I will submit my payment online now

Complete this form, cancel out of PayPal & arrange payment with office at 914-963-3040 *

Date

As the parent/guardian, I agree to serve as the contact/liaison and responsible person for the registered student

Parent / Guardian Signature *

Clear