Registration Form: De Souza School of Music

Once registration is complete, an email with the invoice will be sent within 10 business days. Once the invoice has been received, a 50% non-refundable deposit fee is required for your registration to be valid (unless paid in full or other arrangements are made).

Please note: Information regarding rehearsals, password protected content, etc. will be sent out once a payment plan is in place.

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Student's Full Name

Gender

Date of Birth (Year/Month/Day)

Address

Postal Code

City

Parent/Guardian 1

Parent/Guardian 2

Email 1

Email 2

Home Phone Number

Cell Number 1

Cell Number 2

2021 WINTER/SPRING PROGRAMS

OHIP#

Emergency Contact (name)

Emergency Contact (phone #)

Has your child ever suffered from asthma, heart problems, breathing problems or any other medical condition that may affect his/her ability to participate in this program?

Is your child on any medication?

Does your child have any allergies? Please specify.

Does your child have any behavioral or alternative accommodations? Please specify.

Injury Waiver: Each student and his or her legal guardian(s) hereby release Milton Youth Theatre Productions and Directors, Teachers and Employees from claim for personal injury sustained in, on or about the facilities

Photography & Video Waiver: Each student and his or her legal guardian(s) hereby release Milton Youth Theatre Productions the rights to all photography and video that may be taken by or for Milton Youth Theatre Productions during classes or performances, for use in advertising and promotion, including television coverage.

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