Page 1

ADS FORM - ALL GRADES WINTER 2016-17 PATRON / STUDENT

IN!

ALL FIELDS MUST BE FILLED

Adult Name: __________________________________________________ AV Cust #:____________________ Adult relationship to teen:______________________________________ AV Order #:____________________ Student’s Name :__________________________________________________ Grade: _______________ Adult Address:_______________________________________________________________ ____________ City: ____________________________________________ State: ______ Zip: __________________ Phone: ____________________________ Email: _____________________________________________ Signing up with friends?:_______________________________ How did they hear?: _____________________ Any special needs or allergies? ________________________________________________________ Their Primary Goal for Enrolling? (circle one): FUN

CHILD CARE

CONFIDENCE

PERF. OPPORTUNITIES OTHER

TRAINING IN THEATRE SKILLS

Referred by another Parent? Yes/No: ________ Referral’s Name: ___________________________________

PAYMENT Cash

Check

Visa

MasterCard

Amex

Discover

Sub Total __________________ minus Discounts: $_____________ = Final Total: $ Card #: _________ Security Code__________ Processed by:

Exp. Date:

Please send email confirmation to purchaser & CC Education Director on all email confirmations


Mark the classes for which this student is registering (below or on reverse) PRE-K (Ages 2-4) □ □ □ □ □ □ □ □ □

$15 per Bookworms (Now thru March 4th) – 10:00am – 10:45am Pete the Cat: I Love My White Shoes by Eric Litwin (11/12/16) - $15.00 The Snowy Day by Ezra Jack Keats (1/14/17) - $15.00 Knuffle Bunny by Mo Willems (1/21/17) - $15.00 Where the Wild Things Are by Maurice Sendak (1/28/17) - $15.00 Giraffes Can’t Dance by Giles Andreae (2/4/17) - $15.00 Pinkalicious by Victoria Kann (2/11/17) - $15.00 Harold and the Purple Crayon by Crockett Johnson (2/18/17) - $15.00 Nighttime Ninja by Barbara DaCosta (2/25/17) - $15.00 Pete the Cat and His Four Groovy Buttons by James Dean (3/4/17) - $15.00

GRADES K - 2

□ □ □

□ □ □ □

$160 Musical Theatre (8 Week class, Grade K-2) Saturdays from 10:00AM11:30PM Winter Session (1/14/17 – 3/04/17) □ □ $160 Acting (8 Week class, Grade K-2) Saturdays from 12:00-1:30 PM Winter Session (1/14/17 – 3/04/17) □ □ $20 One Day Workshops (Grade K-2) Musical Theatre Jam: Frog and Toad – Saturday January 21st 1:30pm-3:30pm Musical Theatre Dance – Saturday February 11th 2:00pm-4:00pm Puppet Making – Saturday February 25th 10am-12pm $30 (includes material fee) □ □ □ GRADES 3 - 5 □ □ $160 Acting (8 Week class Grade 3-5) Saturdays from 10:00AM12:00PM Winter Session (1/14/17- 3/4/17) □ □ $160 Musical Theatre (8 Week class Grade 3-5) Saturdays from 12:00PM-2:00PM Winter Session (1/14/17- 3/4/17) □ □ $30 One-Day Workshops (Grades 3-5) Musical Theatre Jam: Frog and Toad– Saturday, January 14th 2:30pm-5:30pm Musical Theatre Dance – Saturday, January 28th 2:00pm-5:00pm Puppet Making – Saturday, February 25th 2:00pm-5:00pm $40.00 (includes material fee)

□ □

GRADES K – 5

□ $50 Play In A Day (One day, for Grades K-5) 10:00AM-3:00PM □ Tuesday, November 8th □ Tuesday, December 27th (Election Day) (Winter Break) □ Friday, November 11th □ Wednesday, December (Veteran’s Day) 28th (Winter Break)


□ Monday, February 20th (President’s Day)

□ Thursday, December 29th (Winter Break) □ Monday, January 19th (MLK Day) □

□ □ □ □ □

□ □ $120 Musical Theatre: Fundamentals (6 Week class, Grade 6-8) Saturdays from 12:30 PM-2:30PM Winter Session (1/28/17 – 3/4/17) □ □ $120 Acting: Fundamentals (6 Week class, Grade 6-8) Saturdays from 3:00 PM-5:00 PM Winter Session (1/28/17 – 3/4/17) □ □ $30 One-Day Workshops (Grades 6-8) Hamilton Workshop – January 21st 11:00am-1:00pm Stage Combat – Saturday February 4th 10:00am-12:00pm Improv 101 – Saturday February 11th 10:00am-12:00pm School of Rock – Saturday February 11th 10:00am-12:00pm □

□ □ □

GRADES 6 - 8

GRADES 9 - 12

□ □ $120 Acting: Process and Performance (6 Week class, Grade 9-12) Saturdays from 12:30 PM-2:30 PM Winter Session (1/28/17 – 3/4/17) □ $120 Musical Theatre: Technique (6 Week class, Grade 9-12) Saturdays from 3:00 PM-5:00PM Winter Session (1/28/17 – 3/4/17) □ □ One-Day Workshops (Grades 9-12)


□ □ □ □

Hamilton Workshop – January 21st 2:00pm-5:00pm $40.00 Stage Combat – Saturday, February 4th 2:30pm-5:30pm $40.00 Director Master Class Series: Acting Shakespeare – Saturday February 18th 10:00am12:30pm $35.00 School of Rock – Saturday February 25th 11:00am-2:00pm $40.00 □

2016-17 Winter ADS Order Form