Class Registration Form

Fill out the Registration Form and mail it with your check made out to Matthews Playhouse.
No confirmation will be sent, but you will be notified if a class is cancelled or changed. Classes
are filled on a first come first served basis. Class size is limited, so please register early. No
registration will be processed without payment  No coupons will be honored after registration.
Partial refunds will be given with a three week notice of cancellation, less a $25 processing fee.
There will be a $25 fee each and every time you switch your class registration to another week.

Note: All students must have been in the designated grade by Sept. 1, 2011.

Name________________________________________________________ Age_______

Date of Birth_________________________________________    Sex    M_____  F_____

Address_________________________________________________________________

City_______________________________________ State_______ Zip_______________

Parent's Name____________________________________________________________

Home Phone__________________________ Work Phone_________________________

Emergency Contact Phone___________________________________________________

Please list any medical conditions, allergies or special needs __________________________

_______________________________________________________________________

Email Address ___________________________________________________________

Class Name_____________________________ Time____________ Tuition__________

Class Name_____________________________ Time____________ Tuition__________

Please fill out one Registration Form per child and mail to: Matthews Playhouse, 100 McDowell
Street,  Matthews, NC  28105       Call (704) 846-8343 for further information

In consideration of the opportunity to participate in the classes and programs offered by the
Matthews Playhouse, I/we release and discharge Matthews Playhouse and it's officers, directors
and agents of and from any claims, demands, liability or damage arising from the participation
of my child in any classes and programs sponsored by Matthews Playhouse.

Signature_________________________________________       Date_____________