Imagination Stage: Our Classes

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Fall 2007 Registration

Please complete the following form to register online and pay by credit card. You may also download a registration form (PDF) and mail or fax it to Imagination Stage.

Class tuition must be paid and registration form must be completed before a student may attend class. Please allow 6 business days from the time you submit the registration form until it is fully processed, your credit card is charged and you receive your email confirmation. (An email confirmation is only sent when a valid email address is provided)

Please review our Fall Registration Policies and FAQs.

Questions: 301-961-6060 or TTY: 301-718-8813

*Please fill in the form. Fields with an asterisk () are required. 1. STUDENT INFORMATION**
*Student First Name / Last Name

*Student Gender

*Student Birth Date (e.g. 6/10/1990)	* Grade in Fall 2007

*Full Name of School Attending

2. PARENT/GUARDIAN INFORMATION
*Parent/Guardian First name/Last Name



*Street Address	*City

*State	*Zip

*Daytime Phone	*Email (Required for confirmation and you will receive important class information from your student’s teacher.)

* Evening/Weekend Phone

Employer

*Emergency Phone

Parent/Guardian #2, First Name/Last Name


Parent/Guardian #2, Employer

Parent/Guardian #2, Daytime Phone

*3. HOW DID YOU FIRST HEAR ABOUT CLASSES AT IMAGINATION STAGE ?
Received brochure in the mail Attended a Performance at Imagination Stage Word of Mouth Children’s Guide to Arts Activities (AHCMC backpack flyer) Magazine Ad, which magazine? Newspaper Ad/Article, which newspaper? Other- Please specify:
4. NOTES/SPECIAL NEEDS
In order to best serve each student, please indicate if your student has any physical, cognitive, emotional, learning or other special needs. We encourage parents to also fill out the Need to Know Form and mail or drop it off at Imagination Stage anytime. You may also leave other notes here for the registration manager or for your student’s teacher.
5. CHOOSE YOUR CLASS You may use this form to register for up to three classes. Please click the drop down arrow to select your class. Class 1
ID#
Day Time Start Weeks Holidays
Tuition
Class 2
ID#
Day Time Start Weeks Holidays
Tuition
Class 3
ID#
Day Time Start Weeks Holidays
Tuition
6. PAYMENT
Your credit card will not be charged immediately. After reviewing your registration form, the registration manager will process your credit card and email you a confirmation. Please allow up to six business days for this to occur. Total Tuition
6a. Payment Plan Add $15 here if you wish to pay using the Split Payment Plan and your total class tuition is $400 or more. Split payments are allowed for families’ tuitions totaling $400 or more and will be assessed a $15 fee. If applying the payment plan for more than one child please note both students’ names in the NOTES section of both registration forms and only apply the plan to one form. Your payment will be charged accordingly: 1st payment (=50% of total tuition+$15) is due at time of registration 2nd payment (=50% of total tuition) will be automatically processed on March 15, 2007 Please Note: Only the total tuition shows at the bottom of this form.
6b. Discounts Our family is eligible for one of the following discounts: No Discounts Our family is registered for more than one class this semester (-$10, If there is more than one student, please note the sibling’s name here: Lerner Family Theatre Subscriber (-$10, One per family per year) Refer a Friend Discount (-$15) read more>> Friends Name: Please Note: Discounts will not be accounted for on this form; the Registration Manager will apply your discount before processing your credit card.

6c. Donations Imagination Stage is a 501.c3 Not for Profit, tax-exempt, cultural and educational organization. Please consider a tax deductible donation to Imagination Stage’s Scholarship Fund. Our family wishes to contribute to the Scholarship Fund: $0 $10 $25 $50 If you would like to contribute more than $50, please contact Barbara Rollins in the Development Department.
6d. TOTAL PAYMENT Total Class Tuition. Payment Plan Fee Donation Total Payment
American Express Master Card Visa
Name on Credit Card * Credit Card# * / Expiration Date (i.e. 10/02)
7. RELEASE AGREEMENT Although every effort is made to provide a safe environment, I recognize there is always a risk of accident. I agree to be responsible for any medical bills incurred resulting from illness or injury during my child’s participation at Imagination Stage. Students are expected to carry their own accident and medical insurance. I release Imagination Stage from any and all liability and/or claims or damages arising out of personal injury of any kind. If necessary, I authorize Imagination Stage to administer first aid and/or authorize medical treatment of my child. I have read and accept all of Imagination Stage's Registration policies and the Release Agreement. Please type your initials here. *

Please only click submit once. Clicking submit more than once will cause an error.

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