Registration Form Student Name Sex ?Write M or F. Age Parent Name ?Please enter the Adult Guardian or Parent's Name Here. Address City Zip Phone Email Camp or Class Name ?Enter the Name of the Camp or Class in which you wish to enroll. Mulan Jr./ Monday's Class Mulan Jr./ Tuesday's Class Mulan Jr. Tots- Tuesday 2:30 Class Mommy and Me Tots- Tuesday 10:30 Class Stop Motion Animation Wednesday 3:00 Technical Production Date I, the undersigned, give permission for my child, to participate in all Youth Entertainer Studio productions. I understand the nature of some activities require qhysical exertion and I believe my child to be qualified and in good health to participate in such activities. I agree to relieve OYES, and their officers, agents or employees from any liability in connection with these activities. I, the undersigned parent of ___________________ a minor, do hereby authorize the staff of OYES, as agents for the undersigned to consent to X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or specialized supervision of any physician licensed under the provision of the Medical Practice Act on the staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office or said hospital. It is understood that this authorization is given in advance of any such diagnosis, treatment or hospital care, which the aforementioned physician in the excise of his best judgment may deem advisable. This authorization shall remain effective for the duration of the program, unless revoked sooner in writing anddelivered to said agent. Parent Signature ?Adult / Parent or Guardian, Please type Your Full Name Here, Indicating your Signature. Emergency Contact ?Please Enter an Emergency Contact Emergency Phone ?Emergency Phone Number Required Allergies Pediatricians Name Pediatricians Phone Other Medical or Special Needs Information: Payment Your registration is not complete and your SPOT IS NOT RESERVED until you Pay Online or call/send in payment to OYES. Cash, check or credit card.accepted.