Classes begin September 5 and 6 (the Tuesday and Wednesday following Labor day)

Sessions to be attended:

(      ) Monday/Wednesday, 4 – 6:30 p.m. (Grades 1-5); (      ) Monday/Wednesday, 5 – 7:00 p.m. (Grades 6-8)

(      ) Tuesday/Thursday, 4 – 6:30 p.m. (Grades 1-5); (      ) Tuesday/Thursday, 5 – 7:00 p.m. (Grades 6-8)

Do you request van pickup at school? (      ) Yes (      ) No (NOTE: May not be available at all schools)

COSTS: Registration fee and first month’s tuition must accompany this form when returned.

Registration fee is $40 (this fee is nonrefundable). Tuition is $120 per month (it is the same each month regardless of the number of classes in that month).

Tuition must be paid on or before the first day – not the first class meeting – of each month. If paid after that date, a late charge of $10 applies. There is a $30 charge for any returned check.

Payment by (      ) Cash (in person only) (      ) Check # _______________ enclosed
(Make checks payable to Cobb Playhouse and Studio, Inc.)

Charge to (      ) Discover (      ) Master Card (      ) Visa
Card # _________________________________________________________ Expires ________________

Waiver of Liability and Release. I, the undersigned, fully understand and agree that the Cobb Playhouse and Studio, its owners and staff shall be free from any liability or claims arising by reason of injury or illness of the child registered above during the term of class sessions the child is attending. Permission is hereby granted to transport this child to a doctor or hospital and to authorize emergency treatment if the parents cannot be reached. I further authorize Cobb Playhouse and Studio to use the student’s name, photograph or other likeness, and/or voice for promotional purposes.

Parents Signature _______________________________________

Date _________________