Phase 2 Acting Co

NAME_______________________________________ AGE________________

STREET_________________________________________________________

CITY________________________STATE__________ZIP CODE_____________

DAY TELEPHONE_______________________EVENING PHONE______________

CELL PHONE___________________________

EMERGENCY CONTACT_________________________________PHONE_________

EMAIL ADDRESS_________________________________

SESSION____________________________TUITION___________________

REFUND POLICY: Withdrawal after first day of class is 50% refund tuition. There are no refunds after the 2nd day of class.

_________________________________I have read the refund policy and agree to them.

Signature of Parent/Guardian

METHOD OF PAYMENT:                PAID IN FULL___________             $100 DEPOSIT______

PERSONAL CHECK #___________          CASH___________             AMOUNT $________

Mail to: Phase 2 Acting Co

                 In Residence at YogaCentric

                 238 Colfax Avenue

                 Clifton, NJ 07013

                 973-338-5693 or 201-349-6913

                 www.phase2acting.com

*Photo Release

I_____________________being the parent/guardian of ________________give my permission/do not give permission to Phase 2 Acting Co that the photographs or videotapes that my child poses for may be use by Phase 2 Acting Co on their website or in flyers.