Summer Registration Form Summer Registration Form Registration Date * Student Information Student's Full Name * Date of Birth * Age * Sex * Male Female School * Grade * Medical Alerts Ethnicity of Student * Hispanic or Latino Not Hispanic or Latino Race of Student * American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White Multi-Racial Please check all that apply Registration Fee/Tuition to all YTI summer classes * I'm a new student - $100 I'm a returning student - $100 Parent / Guardian Information Parent / Guardian Name * Relationship to Student * Street Address * Apt. # City * State * Zip Code * Preferred Phone Number * Alternate Phone Number * Email Address * Emergency Contact Name * Phone Number * Relationship to Student * Returning Students Date of Last Registration Semester Winter-Spring 2020 Fall 2019 Summer 2019 Winter-Spring 2019 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, not due to the negligence of said personnel. Parent / Guardian Signature * Clear Date * Δ