Youth & Teen Class Registration » Laughtrack Theater Company - Honolulu's Home of Long Form Improv Comedy

Youth & Teen Enrollment Form

Dear Parents and Applicant: Thank you for your interest in the After School Program (ASP) at Laughtrack Theater Company. Please fill out this application form completely. The registration deadline is 5 days before the start of the class session you want to register for. Your child will not be registered until the payment is made.

Step 1 of 6

16%

Applicant's Name*
FirstLast
Gender
- Male
- Female
Age*
Date of Birth*
Name of School:
Grade:*

Parent / Guardian Information
Please provide parent / guardian information for the legal guardian who is enrolling the applicant
Parent / Guardian Name:*
FirstLast
Permanent Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Home Phone*
Mobile Phone:*
Work Phone*
Email*
Employer*
Occupation:
Employment Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
How did you hear about our program?*

Emergency Contact Information
Emergency Contact: Please list in order of preference, individuals we may contact in the event of an emergency.
Contact #1
Emergency Contact #1*
FirstLast
Emergency Contact #1 Address:*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal Code
Emergency Contact #1 Phone:*
Emergency Contact #1 Mobile Phone:*
Emergency Contact #1 Email
Relationship to Child:*
Contact #2
Emergency Contact #2
FirstLast
Emergency Contact #2 Address:
Street AddressAddress Line 2CityState / Province / RegionZip / Postal Code
Emergency Contact #2 Phone:
Emergency Contact #2 Mobile Phone:
Emergency Contact #2 Email
Relationship to Child:

Applicant Information
Child’s Physician or Clinic’s Name (Child’s Primary Health Source)*
Pyhsicians's Name*
FirstLast
Physician's Phone*
Does your child have physical limitations, health disorder, or developmental disabilities which would limit his/her participation in the training center programs and activities?*
- Yes
- No
If yes, please specify:
Does your child have allergies (insects, medications, food, etc.)?*
- Yes
- No
If yes, please specify:
Is there any other information you would like to provide?

Pick Up Information
List person(s) authorized to sign your child out from class:
Pick Up: #1 Name:*
FirstLast
Phone*
Relationship:*
Pick Up #2 Name:*
FirstLast
List person(s) authorized to sign your child out from class:
Phone*
Relationship:*
Pick Up #3 Name:
FirstLast
List person(s) authorized to sign your child out from class:
Phone
Relationship:

Enrollment
Quantity
Youth & Teen Program
Price: $225.00
Total
$0.00

Youth & Teen Enrollment Form

Step 1 of 6

Parent / Guardian Information

Emergency Contact Information

Contact #1

Contact #2

Applicant Information

Pick Up Information

Enrollment

Classes