SUMMER THEATER ENRICHMENT APPLICATION

SUMMER THEATER ENRICHMENT
APPLICATION
A theater & performing arts program for children ages 6-11
Checks made payable to Kenan Center and sent to: 433 Locust Street, Lockport, NY 14094 ATTN: Heather Bowen
Last Name
Gender
Male
First
Middle
Date
Age
Home Telephone
Female
Home Address
City
Other Telephone
State
ZIP
School
Grade
Full Name of Maternal Parent/Guardian
Best Contact Phone (circle one) home /work /cell
Full Name of Paternal Parent/Guardian
Best Contact Phone (circle one) home /work /cell
Parent Email Address
Emergency Contact
Phone #
Relationship
WEEK OF PARTICIPATION: Monday, July 27 – Friday, July 31 from 9:00 am – 1:00 pm.
Each class will take place in the Taylor Theater Meeting Room and/or Taylor Theater with a performance on the evening of
July 31.
COST: $40.00
To be included with application. PARTICIPATION IS NOT GUARANTEED without application AND payment.
*All materials are included.
WAIVER
I, the undersigned parent/guardian of _________________________________(child’s name), do hereby grant permission to
participate in any and all of the activities of the Kenan Center’s Whimsical Sculpture Project. I agree to be legally and
financially responsible, and agree to hold harmless the Kenan Center and its officers, agents and employees, from any and all
claims or actions arising against or in favor of my child or myself as a result of any act by, or event, occurrence, or accident,
happening to my child. I hereby give my permission for photographs and/or videos of my child to be used in promotional and
website materials in connection with this program and the Kenan Center.
Parent/Guardian Name (PRINT)
Signature
Date
ACCEPTANCE
There are a limited number of spaces available each week so parents are urged to apply as soon as possible. You will receive
notification prior to the start of the program confirming your child’s acceptance as well as further details on schedules,
classroom locations, and staff contacts.