Academy Registration Form

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Registration Information

All forms must be completed in their entirety. Please note: If you are auditioning for The Theory of Relativity registration is open only after auditions and casting.
Student Name *
School Attending *
Student's Email Address *
Date of Birth *
Grade Attending in the Fall *
Student's Mobile Phone Number
1st Parent/Guardian *
Mobile Phone Number *
Mailing Address *
Email Address *
Secondary Phone Number
City, ST  Zip Code *
2nd Parent/Guardian (Optional)
Mobile Phone Number
Mailing Address
Email Address
Secondary Phone Number
City, ST  Zip Code
Emergency Contact (Secondary) *
Mobile Phone Number *
Work Phone Number
Relationship *
Home Phone Number
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Release Form

Due to PBD’s safety policy, minor children may only be picked up by a person on the approved pick-up list. An ID will be required at pick up.
The following adults are approved to pick up my child. Please list any and all adults:
My child will drive themselves: * Students who drive themselves will not be required to include names on the approved pick up list.
Acceptance of Hold Harmless Agreement *

I agree to release, discharge, and hold harmless Palm Beach Dramaworks and its officers, directors, employees, and agents from and against, any and all claims, damages, losses, liabilities, demands, suits, judgments, causes of action, legal proceedings, penalties, fines and fees directly or indirectly arising from the negligence of Palm Beach Dramaworks or from participation of my child in any classes, or productions sponsored by Palm Beach Dramaworks. By initialing here, I understand the Hold Harmless Agreement.

Acceptance of Photo Release *

I hereby consent to the use by Palm Beach Dramaworks, without limitation, obligation, or compensation, of photographs, film footage, or tape recordings of my child for the purpose of marketing/advertisement. By initialing here, I understand the Photo Release policy.

Acceptance of Late Pick Up Policy *

I understand that my child must be picked up promptly at dismissal time. As a courtesy for emergency situations only, PBD allows a 15-minute grace period (which includes a phone call notification) after the conclusion of a class or rehearsal. A charge of $1 per minute after that time may be incurred. By initialing here, I understand the Late Pick Up Policy.

Acceptance of Refund and Cancellation Policy (Classes and Productions) *
  • All refunds for withdrawals incur a $100 administrative fee per production or class. 
  • All withdrawal requests must be sent in writing to [email protected]
  • If a student withdraws from a production or class 15 days before or longer than the first day of the production or class, the registration fee is refunded less the $100 administrative fee.
  • If a student withdraws from a production or class at any time 14 days prior to or any time after the first day of the production or class no refunds are given. The exception is for a medical purpose, which requires a physician’s note. In the event of withdrawal due to a medical issue, the registration fee is prorated (if rehearsals or class is already in session), the unused portion is refunded, and the administrative fee is waived.
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Medical Form

List Student's Allergies:
Please describe how staff might recognize your child’s allergic reaction. Basic first aid, such as adhesive bandages and ice packs, are available. PBD staff does not administer pain relievers or other medications to students:
Require an EpiPen? *If yes, you will be asked to complete the Severe Allergy/ Epipen Form available on the first day of class/rehearsal.
ADD/ADHD? *
Asthma/Inhaler? *
Depression? *
Diabetes? *
Mental Health Challenges? *
Dietary Restrictions? *
Anxiety? *
Behavioral Issue? *
Developmental Delays? *
Epilepsy? *
Activity Restrictions? *
Please explain in detail for any questions that were answered YES:
Please list any other medical information the PBD staff should have about your child:
Is there anything else you wish to share about your child?
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Health Insurance / Doctor Information

Family Doctor Name
Insurance Company / Plan Name
Full Name of Policy Holder
Health Insurance Policy Number
Doctor’s Phone Number
Insurance Company Phone Number
Policy Holder Phone Number
Insurance Group Name or Number
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Medical Waiver

Accept Terms *

In the event of an emergency, I understand that every effort is made to reach me to obtain my guidance on my child's care. In the event Palm Beach Dramaworks cannot reach me, I authorize Palm Beach Dramaworks to obtain medical attention for my child at a physician's office or hospital.

I attest that all of the information I have entered is accurate, and I have read and understand all of the policies presented by Palm Beach Dramaworks. (Please sign) *
Clear
Full Name of Signee *
Submit
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