Class Name:

Class Name

Class Start Date :

-- mm/dd/yy

Student's Name:

Name

Birth Year:

Parent/Guardian Info:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Any conditions instructor should be aware of?

Doctor Name:

Name
Work Phone

Student Agreement (for students under 18 years of age)

I understand that Majestic Theatre Management classes are intended for highly motivated students who seek quality instruction in the performing arts.  I will attend class regularly and concentrate on the activities at hand.  If I am disruptive in class, I understand that I may be dismissed from class and will not be entitled to a refund of my tuition.

Student Agreement - Check to Accept

Release of Liability (adult students and parents of minors must agree)

Your Electronic Signature below indicates that you have agreed or given permission for your child to participate in this program during the times specified in the schedule and that you agree to indemnify and hold harmless Majestic Theatre Management, the instructor, The MTM Education Director, the City of Corvallis, the individual members of Majestic Theatre Management and City of Corvallis agents and employees from and against any and all suits or actions of whatever nature resulting from or arising out of your or your child's participation in this program, either the instructors or the city, their agents or employees.  I understand and agree to the above instructions and agreement by typing my name in the electronic signature box below.

Electronic Signature:

Name

When you click submit form your form will be submitted and you will be taken to the secure payment page.  Please understand that our facility is in Corvallis, Oregon.