Trinity Repertory Company | Wait List Form

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Billing Information

Nombre de contacto

Apellido de contacto

Correo electrónico

Número de teléfono Móvil

Dirección de correo

Ciudad


Código postal



Contact 2

Nombre de contacto

Apellido de contacto

Otro correo electrónico

Número de teléfono alternativo



Estado

Código postal

 
Class







$

$



Class Participant

Nombre de Niño

Apellido del Niño

Correo electrónico

Escuela del Niño/a

Cumpleaños

Grado

Pronombres (él, ella, ell@s)

Género


Edad del Niño/a


Ex. to subtract $50 from the Item Total, enter "-50" here (without the quotes)
Class







$

$



Class Participant

Nombre de Niño

Apellido del Niño

Correo electrónico

Escuela del Niño/a

Cumpleaños

Grado

Pronombres (él, ella, ell@s)

Género


Edad del Niño/a


Ex. to subtract $50 from the Item Total, enter "-50" here (without the quotes)
Emergency Contacts

Who should we contact in case of an emergency?

Emergency Contact




Emergency Contact #2




Terms and Conditions

I agree to release, indemnify, and hold harmless Trinity Repertory Company well as all Trinity Repertory Company  employees, agents, representatives, successors, etc. from all losses, claims, theft, demands, liabilities, causes of action, or expenses, known or unknown, arising out of my student’s participation.

I grant permission to Trinity Repertory Company, its employees and agents, to take and use visual/audio images of me. Visual/audio images are any type of recording, including photographs, digital images, drawings, renderings, voices, sounds, video recordings, audio clips or accompanying written descriptions. I agree that Trinity Repertory Company owns the images and all rights related to them. The images may be used in any manner or media without notifying me, such as Trinity Repertory Company-sponsored websites, publications, promotions, broadcasts, advertisements, posters and theater slides. I waive any right to inspect or approve the finished images or any printed or electronic matter that may be used with them.

I release Trinity Repertory Company and its employees and agents, including any firm authorized to publish and/or distribute a finished product containing the images, from any claims, damages or liability which I may ever have in connection with the taking of or use of the images or printed material used with the images.

I am at least 18 years of age and competent to sign this release. I have read this release before signing. I understand its content, and I freely accept the terms.
Donation

$
Payment

$

$
$
$

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$
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Credit Card Information