Stagedoor Manor Studios Application Stagedoor Manor StudiosStudio Selections* Studio 2 - Additional OptionsChoose OneAuthor (space limited)Actor* All three Studios will be located at Shetler Studios 244 W 54th St, New York, NY 10019** Broadway show ticket price is not included!Student's Email Address Enter Email Confirm Email Parent's Email Address* Enter Email Confirm Email Name* First Last Age (At Time of Workshop)*Date of Birth* Parent / Guardian 1* First Last Relationship*Parent / Guardian 2 First Last RelationshipHome Phone*Cell PhoneAddress* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Emergency Contact Other Than Parent / Guardian* First Last Phone*Relationship*If you would like this emergency contact to have the legal right to sign your child out of the studio program for any reason, please include them in Student Contact Information section. MedicationsAllergiesDietary NeedsSchool Name*Student's Contact InformationCell Phone*Hotel or Location*Where is Child Staying?Where will the parents or guardians be during the workshops?*Please Choose and E-Sign*My Child DOES NOT have permission to leave rehearsal without me. I will pick him/her up every day.My Child has permission to leave rehearsals with friends, on his/her own, or with the family listed below:Family Members* Fill out only if you chose the second option aboveParent E-Signature*Where Did You Hear About Us?Student ContractBecause we want to provide the best possible experience for every student, Stagedoor Manor Studios has developed policies designed to ensure a safe, productive and friendly community. Your (electronic) signature on this contract indicates your agreement with these policies. Anyone who violates these policies may be removed from the program without refund.*1. I hereby verify that I will be between the ages of 12-18 at the time I attend Stagedoor Manor Studios. 2. When NOT at classes, rehearsals, performances, or scheduled events, Stagedoor Manor Studios is not responsible for the student’s supervision. 3. Being on time and present is mandatory! Orientation will begin on Friday at 6:00 pm and classes will begin Saturday at 9:00 am. 4. All students, and family traveling with them, will be responsible for their own transportation and accommodations for the duration of the program. We have blocked rooms at Hotel Edison (228 W 47th St, New York, NY 10036) for your convenience. Parents are not allowed in classroom studios. 5. No student may use or have possession of any illegal drug while at Stagedoor Manor Studios or on any property or excursion outside of the studios. 6. No student may use or have possession of alcohol while on studio property or on any excursion outside of the studios. 7. Violent action to other people, property or to yourself is prohibited. You may not physically strike anyone under any circumstance. Students, staff, and parents agree to respect all members of the community and will refrain from abuse or intimidating language or mistreatment of any kind. 8. Students agree to remain on studio property during program hours. 9. Students agree not to deface or destroy studio, hotel, or theater property. Parents will be held financially responsible for any damages. 10. Campers must wear appropriate footwear during studio hours. 11. Gum chewing is not permitted during program hours. 12. No cell phones may be used during program hours except as a recording device or during breaks. 13. Stagedoor Studios, its officers, directors, members and employees shall not be responsible for student’s clothing or personal possessions lost or damaged by theft, laundry, fire, malicious mischief, or otherwise. Stagedoor Studios specifically advises against bringing jewelry, or valuables to the studio property. The undersigned have read this contract and understand and agree to all terms and conditions and all policies Student WaiverThe undersigned, for good and valuable consideration, which includes the opportunity to participate in the Stagedoor Manor Studios does hereby make the following representations and agreements to Stagedoor Manor Studios, its parent and affiliated companies and each of their respective officers, directors, employees, agents, insurers, successors and assigns, and Stagedoor Enterprises, Inc. and each of its respective officers, directors, employees, agents, insurers, successors and assigns (all collectively referred to as the “Releasees”). Specifically, the undersigned, on his/her own behalf, or on behalf of his or her child, if such child in under the age of eighteen, as applicable (collectively, unless otherwise specifically provided, “Releasor”), does hereby state that:*1.Releasor does hereby agree that Releasees may utilize Releasor’s name, image and biographical data to publicize Releasees and/or the Stagedoor Manor Studios in any and all media and from and after this day, in perpetuity without any further compensation, consent or approval. It is specifically acknowledged and agreed that the Releasees and their designee(s) shall have the right to exploit the Stagedoor Manor Studios and the Releasor’s participation therein and that this grant to Releasees is unqualified and unlimited. 2. Releasor does hereby indemnify, defend, release and hold Releasees harmless from any liability, damages, causes of action, claims, actions, suits, controversies, judgments, costs and expenses, including, without limitation, any and all expenses incurred in respect of attorneys’ fees and expenses as may relate to or otherwise arise as a result of any Releasor’s participation in Stagedoor Manor Studios and/or any travel or other practice, rehearsals or happening associated therewith. It is the intention of the Releasor that Releasees shall have no liability whatever for any harm caused to any Releasor or caused by Releasor to any third person in respect of any circumstance whatever relating to any Releasor participation in or association with Stagedoor Manor Studios and/or any travel or other practice, rehearsals or happening associated therewith. 3. The undersigned hereby represents and warrants that the undersigned is at least eighteen (18) years of age of if less than eighteen (18) years of age as of the date hereof, that a parent or legal guardian has signed such document in respect of such participant. 4. It is specifically acknowledged and agreed that the undersigned has the authority to execute this Agreement and Release on behalf of the Releasor. The undersigned have read this waiver and understand and agree to all terms and conditions and all policies Student E- Signature*Date* Coupon Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Security Code Cardholder Name NumberNumberNumberEmailThis field is for validation purposes and should be left unchanged.