Prana Summer Acting 2015 Registration Form
Early-bird discount EXTENDED to Feb. 6 - sign up today!

Please print out/mail to Prana, 21 Charles St., Holliston, MA 01746 w/payment.

Student’s name ____________________________________________________

Student’s age  _____  Grade (entering) ______  Gender ____

T-shirt size: [ ] Child Large [ ] Adult Small  [ ] Adult Medium   [ ] Adult Large

Second Student’s name_____________________________________________

Second Student’s age _____  Grade (entering) ______  Gender ___

T-shirt size: [ ] Child Large [ ] Adult Small   [ ] Adult Medium   [ ] Adult Large
Medical needs or allergies_________________________________________

Learning style/anything you'd like us to know about your child.________ ________________________________________________________________
Parents’ Name(s)_________________________________________________
Address__________________________________________________________________
Home phone Number

Please list as many numbers you can in the unlikely event of an emergency:
Parent name _____________ Parent Cell Phone __________________  Parent work phone ______________
Second Parent Cell ___________________ Work Phone __________________ Emergency Contact __________________________
Student's email  __________________   Parent email __________________
How did you hear about this program?___________________________

Summer Stock has its own page ... click here ...

Refund policy: Your tuition is nonrefundable UNLESS we are able to fill your child's spot, in which case we will refund your tuition less a $25 handling fee. 

Please read and sign the following. Your signature indicates you have read, understand and agree to comply with the statements listed here:  I release the Prana Center and staff from all liability in connection to any personal injury and/or damage to or loss of personal property while engaged in program activity. In the event of a medical emergency, I grant the staff permission to engage in first aid (if trained) and if necessary to transport or have my child transported to the nearest Emergency Medical facility.

It is my responsibility to cover any fees resulting from a check which has been returned by the bank.

I give Prana Center permission to use pictures of my child in publicity and/or on their website, facebook pages, or other electronic media.

Date ___________      Signature of Parent or Guardian _______________

Please make checks payable to Prana Center.  Mail to Prana Center, 21F Charles St., Holliston, MA 01746.  Questions?  roberta@pranacenter.com