Saturday Program Registration

Instructions: Please complete this registration form for each child you are registering.
Student First Name(Required)

Student Last Name(Required)

Student's Gender(Required)

Student's Date of Birth(Required)
Month
Day
Year

Choose Your Saturday Improv Class(Required)
Each class is 10 weeks/session, from January 14 through March 18

Improv for Kids - 5 to 7 Years Old, Saturdays at 10am

Improv Comedy for Kids - 8 to 10 Years Old, Saturdays at 11am
2 payments of $175.00 billed the 1st of each month will be processed. If your student is new to us we will also process a non-refundable first-time processing fee of $35.00.
Emergency Contact Information
Please provide preferred phone numbers and email addresses for parents/caregivers.
Parent/Legal Guardian (First Emergency Contact)(Required)

Relation to Child(Required)

Phone(Required)
Email(Required)

Street Address

City

State

ZIP Code

2nd Parent/Legal Guardian (Second Emergency Contact)

Relation to Child

Phone
Email

Additional Contact

Relation to Child

Phone
Does the student have any special physical (including allergies), behavioral, learning and/or other needs our staff should be aware of?

No

Yes
Please describe your child's needs. (NOTE: session costs will not be refunded if a child is asked to leave due to unsafe or repeated disruptive behaviors.)(Required)
How did you hear about us?

Payment
Select a payment method(Required)

Use payment method on file

Use different payment method (a payment authorization form will be sent to you.)
2 payments of $175.00 billed the 1st of each month will be processed. If your student is new to us we will also process a non-refundable first-time processing fee of $35.00.

Payment and Cancellation Policy (Non-Negotiable)

I understand there is a one-time, non-refundable processing fee of $35.00 for each new student.

I understand that $175.00 will be charged automatically on September 1 and October 1 using the payment method on file.

I understand there is a $40.00 fee for any rejected debit from your financial institution.

I understand there is a late pick-up charge of $25.00 per every 10 minutes late; automatically charged.

I consent to ILS keeping my signature on file to initiate a debit or credit card transaction on an ongoing basis in the amount due for session tuition payments and fees.

I understand that withdrawal must be submitted in writing, via email and will be acknowledged within a 14-days of the start of the session.

Medical Consent  I hereby consent to allow ILS to seek emergency medical treatment, including ambulatory transport if required, for the child named on this registration. I authorize first-aid care as necessary to preserve the life, limb and well-being of my child. If it is necessary for the child to be transported to receive emergency care at Children's Hospital, I will be responsible for all charges not covered by insurance. I consent for the emergency contact listed on the registration form to ACT ON MY BEHALF until I am available. I agree to review and update this information whenever a change occurs.

Removal from Program due to Behavioral Issues  I understand that ILS has a Zero Tolerance Policy for bullying and children who do not comply may be asked to leave immediately without refund if behavior cannot be reasonably corrected.

Photo Release Agreement  I understand that from time to time Illumination Learning Studio takes photos of students engaged in its programs for use on their social media or on their website. While photos are used exclusively without identifying a student's name or other personal information or age, I understand that I may request any photo be taken down.

Agreement(Required)
By checking the box here, I agree I have read, understand and agree to the Payment and Cancellation Policy, the Medical Consent, Behavioral and Photo Release statements above. In addition, I have received and understand the terms and conditions outlined in the Parent Handbook Studio Policies.

Instructions: Please complete this registration form for each child you are registering.

Emergency Contact Information

Payment

Payment and Cancellation Policy (Non-Negotiable)

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