Peanut Butter & Jelly Players REGISTRATION 2018 “Little Mermaid, Jr.”

Please fill out COMPLETELY! There is a required age range for the child actors. The youngest age group of children must be 3rd grade in the Fall of 2018 (no exceptions) and the oldest is 18 years of age or entering their senior year of high school. Maximum of 2 children per family allowed to register. All children must be current on vaccinations.

Rehearsal & Play Information

Rehearsals will be Mon. through Fri., 8:00 a.m. until Noon, starting on Weds., May 30*, 2018. (*Monday is Memorial Day) The Play will run June 22-24, 2018. Children HAVE to make all the rehearsals to be in the play. Children will not be able to skip rehearsals for vacations, camps, etc. If you see that there will be a conflict during the rehearsal/play run, please do not register your child. DO NOT CONTACT SHOW DIRECTOR FOR EXCEPTIONS.

CHILD’S INFORMATION

1. Name: _________________________________ 2. Age: ___________________

First/Last (print legibly) (age at the end of May 2018)

3. What grade is your child entering in the Fall of 2018? :_________________________

4. What role is your child interested in playing? If he/she is open to any role, please

write “any.” ____________________________________________________________

PARENT/GUARDIAN INFORMATION

5. Address: ____________________________________________________________

Street / City / State / Zip Code

6. Email address (required) Email addresses will be the primary way we contact your

child for rehearsal & play notifications. PRINT LEGIBLY . _________________________________________________

7. Mother’s FULL NAME: _______________________________________________

8. Mother’s PHONE (include area code)

Home #: __________________________ Cell #: _________________________

9. Father’s FULL NAME: _______________________________________________

10. Father’s PHONE (include area code)

Home #: __________________________ Cell #: _________________________

11. EMERGENCY CONTACT (If parents/guardians cannot be reached

Full Name: __________________________ Phone #: ____________________

PBJ Registration 2017-18 form - GOOGLE DRIVE Page 1

MEDICAL INFORMATION Please enter any allergies, medical issues, etc., that will be important for the safety of your child. All participants must be current on their vaccinations. Please include vaccination record for each child with registration packet.

Note: All forms mentioned are also online at www.MatthewsOpera.com under “Performing Arts > Children’s Theater.” REFUNDABLE Registration Deposit There is a $25 (per child) deposit. This deposit will be REFUNDED in FULL when the child/children successfully complete the entire summer theater camp, through the play's performances. Please note that deposits will NOT be refunded if the child(ren) withdraws before or during theater camp. CHECKLIST Registration is on a first-come basis; after registration is full, a waiting list will be started. The complete packet of registration forms and the $25 deposit must be received for your registration to be complete and accepted. Incomplete registrations will not be accepted. ALL registrations must be either postmarked or dropped off at the arts center by May 15, 2018. NOTE: Camp may be full before this date. Registration status will be confirmed after May 15. DO NOT CONTACT The Matthews prior to this date to inquire about the status.

Incomplete registrations will not be accepted. _____ 1. Registration form. _____ 2. Signed Liabilities & Waivers form. _____ 3. Signed Actors Contract.

_____ 4. Signed Pick-Up & Drop-Off Information form.

_____ 5. Current vaccination record for each child.

_____ 6. $25 refundable deposit for each child. Make check out to The Matthews or MOH . ____ Please use my deposit as a donation to The Matthews for children’s

outreach and programming. Parent/Guardian: How will you volunteer to help? ___ helping during rehearsals ___ as usher/helper during play ___ set building ___ assist with set clean-up after Sunday performance

PBJ Registration 2017-18 form - GOOGLE DRIVE Page 2

MEDICAL & LIABILITY RELEASE

612 N. Main St. | Spearfish, SD 57783 | 605.642.7973 | www.MatthewsOpera.com

Peanut Butter and Jelly Players Summer Children’s Theatrical Program: May 30 – June 24, 2018 Disney’s Little Mermaid, Jr. production Medical Release: In case of an emergency and I cannot be reached, I authorize the staff and volunteers of the Matthews Opera House & Arts Center to obtain whatever medical treatment deemed necessary for the welfare of my child:

_______________________________________________ I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of whether or not my medical insurance would cover such charges and fees. I have identified all medications my child is currently taking on the registration form, as well as provide any other pertinent medical information that would be necessary if my child needed emergency treatment. Liability Release: I hereby give my consent for my child’s participation in the activities of The Matthews Opera House & Arts Center Peanut Butter and Jelly Players Summer Children’s Theatrical Program from May 30-June 24, 2018. I understand that participation may involve a degree of physical risk; I have carefully considered this risk and I hereby give my child, _____________________________________, permission to participate. I hereby absolve and release the Matthews Opera House & Arts Center and its staff, volunteers, board members, and other representatives, from any and all claims and liability for any injuries and damages that may be incurred by my child in the activities sponsored by this program. Having read and understood and being in agreement with this document, I have signed and dated this agreement below: Date: _________________________________ Parent Signature: _____________________________________________________ Parent Name (Printed): _____________________________________________________ Child’s Name (Printed): _____________________________________________________

Email any questions to: director@matthewsopera.com

PBJ Liabilities & Waivers 2017-18 - GOOGLE DRIVE

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DROP-OFF and PICK-UP INFORMATION

612 N. Main St. | Spearfish, SD 57783 | 605.642.7973 www.MatthewsOpera.com

Peanut Butter and Jelly Players Summer Children’s Theatrical

Program: May 30 - June 24, 2018.

Disney’s Little Mermaid, Jr. production

DROP-OFF INFORMATION: Is your child being dropped off by you or a guardian at The Matthews each day? Yes ____ No _____ If “yes,” please write the name AND phone number of the person dropping off your child. ___________________________________ Phone: ( ) _________________ If “no,” how is your child arriving each day? (bus / walking / cab, etc.) ____________________________________________________________________

PICK-UP INFORMATION: Is your child being picked by you or a guardian at The Matthews each day? Yes ____ No _____ If “yes,” please write the name AND phone number of the person picking up your child. ___________________________________ Phone: ( ) _________________ If “no,” how is your child leaving each day? (bus / walking / cab, etc) ____________________________________________________________________

NOTES: If there is a change to any drop-off or pick-up instructions at any time, Ms. Froelich needs a SIGNED note from the parent/guardian. Please initial to confirm reading & agreeing to this statement. Initials _________ ------------------------------------------------------------------------------------------- The front door of THE MATTHEWS Opera House will be open every rehearsal day 7:45

a.m. until 8:15 a.m. After that time, the doors will be LOCKED. Therefore, make sure that your child arrives in a timely manner each day! Please initial to confirm reading & agreeing to this statement. Initials _________

PBJ Drop-off / Pick-up Information 2017-18 form GOOGLE DRIVE

Peanut Butter & Jelly Player’s Contract

I agree to be a member of the Little Mermaid, Jr. company and will: ● Come to all rehearsals prepared and on time ● Always be respectful of my teachers and my fellow company members ● Ask the director if I have a question ● Not miss ANY rehearsals ● Learn my part and perform to the best of my abilities ● Pitch in when help is needed ● Have fun

I understand that my failure to follow these guidelines may prevent me from

being able to perform in the show.

Signature: _______________________________________

Printed Name: ____________________________________

Date: ___________________________

PBJ Contract - 2017-18 DRIVE