Secure registration

Annie Jr. · Young Performers

Saturdays · 11:00 AM–12:00 PM · Dates TBD · JCC Kersten Center – Northbrook

$355 per child

1. Your details—2. Review & pay

Parent / Guardian

This is the adult we will contact about your child's registration.

First Name *Last Name *Email *Your confirmation and receipt go here.

Child

Child’s Name *Program *

JCC Kersten Center – Northbrook · 255 Revere Drive, Northbrook, IL

Photo/Video Consent *

I give permission for my child/children to be photographed, filmed, or recorded during Children’s Theatre Company activities, and for these images to be used for promotional purposes (social media, print materials, and the CTC website) without compensation.

I give permissionI do not give permission

Emergency contact

Who should we call if something happens during class?

Emergency Contact Name *Emergency Contact Phone *Format: (000) 000-0000.Allergies / Medical NotesWrite “None” if none.

Risk Acknowledgment & Consent

Complete the form to confirm participation terms, emergency contacts, and photo/video consent for your child.

On behalf of myself, my household members, and as parent and lawful guardian of the minor child/children named above, by completing and submitting this form I acknowledge and agree to the following:

1. Assumption of Risk and Release of Liability

I acknowledge that participation in activities at the Children’s Theatre Company involves inherent risks, including but not limited to physical injury. I voluntarily assume all risks associated with such participation and hereby release, discharge, and hold harmless the Children’s Theatre Company, its employees, agents, and representatives from any and all claims, damages, or liabilities arising from my child’s/children’s participation in these activities.

2. Emergency Medical Treatment (draft: confirm with your insurance agent)

In the event of an injury or medical emergency, I authorize Children’s Theatre Company staff to seek emergency medical treatment for my child/children if I cannot be reached. I agree to be responsible for any costs of such treatment.

I have read and agree to the terms above. *

Parent/Guardian Signature *

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Date *

1 child · family total $355