Question Title

* 1. Student Name

Question Title

* 2. Student Date of Birth

Date / Time

Question Title

* 3. I understand that I will be contacted by Pistarckle staff and given the next
steps and any additional paperwork needed to finalize and complete this
registration.

Question Title

* 4. I attest that all information included in Sections 1, 2, 3 and 4 of this
registration are true and accurate to the best of my knowledge and that I am an authorized parent/legal guardian for this student and am able to make
decisions about his/her enrollment.

Question Title

* 5. I attest that this student does not have any physical, social - emotional or
cognitive impairments that would prohibit his/her safe participation or the
safe participation of others in the Starz program.

Question Title

* 6. I give consent for Pistarckle Theater to give my student  ibuprofen or Tylenol upon their request during camp days within the limits prescribed on the
bottle

Question Title

* 7. In the event of an emergency, I give Pistarckle consent to have my student
attended to by EMT's or transported by Ambulance if I am not able to be
immediately contacted.

Question Title

* 8. I agree to fulfill any and all payment arrangements that I enter into for tuition or fees related to the Starz program. 

Question Title

* 9. I consent to images of my student from camp, either in still or video, being
used in all promotional materials that Pistarckle may use during and after the Starz camp. 

Question Title

* 10. I understand that if my student offered a scholarship that I am responsible
for completing and/or providing all validating documents in the time frame
assigned at the time the scholarship is offered pending validation. I
understand that failure to follow such timeframes may result in the
scholarship opportunity being revoked. I understand that any offer of scholarship assistance is only a pending offer until such time as documents are
submitted and validated and that I and my student will be required to attend a brief interview with Pistarckle in order to certify the scholarship offer. I
further understand that by accepting any scholarship that my students is to
attend program for the entirety of 6 wees x 5 days plus performances. I agree that if I am not awarded scholarship money for any or all of the program, I am responsible for payment of all sessions whether or not my student attends. 

T