Please mail or fax this form and payment to: Berkeley Rep School of Theatre, Nevo Education Center, 2025 Addison Street, Berkeley, CA 94704. Phone: 510.647.2972. Fax: 510.647.2979. E-mail: school@berkeleyrep.org. STUDENT NAME STUDENT E-MAIL * PARENT NAME (for students under 18) PARENT E-MAIL * SCHOOL (for students under 18) GRADE * Please note: To save paper, e-mail will be the primary source of communication between the School and its students. Please supply us with an address that you will check regularly. Thanks! ADDRESS CITY, STATE, ZIP PHONE (home) PHONE (work) EMERGENCY CONTACT PHONE RELATIONSHIP TO STUDENT Are there any pre-existing medical conditions or allergies that the Berkeley Rep School of Theatre should be aware of? I would like to register for the following Fall 2006 course(s) 1. CLASS NAME and TUITION AMOUNT 2. CLASS NAME and TUITION AMOUNT Please pay by check made out to Berkeley Repertory Theatre or fill out the necessary credit card information. PLEASE CIRCLEVisaMasterCard CREDIT CARD NUMBER EXPIRATION DATE NAME AS IT APPEARS ON THE CREDIT CARD SIGNATURE DATE How did you hear about this class? I give Berkeley Repertory Theatre the absolute rights and permission to publish and/or copyright photographs of myself and/or my child. These photographs may be used for marketing and publicity purposes, in any medium, without compensation to myself and/or my child. I hereby waive any right to inspect or approve the finished product, including written copy that may be created with said photographs. By providing my e-mail address, I’m signing up to receive online correspondence from Berkeley Repertory Theatre. I can tailor my personal account to receive the type of information I want after I am signed up and can unsubscribe at any time. My e-mail address will never be traded or sold. I agree to hold Berkeley Repertory Theatre, its board of directors and employees free and harmless from any and all claims, costs, losses, damages, recoveries, settlements and expenses of any nature or kind which may be incurred by participation in School activities. Disruptive or disrespectful behavior is not tolerated and will result in immediate expulsion from the Berkeley Rep School of Theatre with no refund. STUDENT SIGNATURE DATE PARENT SIGNATURE (if student is younger than 18) DATE REGISTRATION POLICIES —All registrations are processed in the order they are received. Registrations will be accepted until the class is full or until the end of the first week of class, whichever comes first. —Returned checks: A $25.00 service charge will be attached to any check returned by the bank due to insufficient funds. —Class confirmations: After your registration is processed, you will receive information confirming your spot in the class. —Cancellation Policy: If you cancel before class begins, we will refund tuition less a $50.00 processing fee per class. If you cancel within 24 hours after the first class meeting, we will refund half the tuition amount. After 24 hours after the first class meeting, no refund will be given. —We reserve the right to cancel a class if enrollment is insufficient. In this instance, any tuition paid will be refunded in full. —Berkeley Repertory Theatre is not responsible for any lost, damaged or stolen personal belongings. —All dates, times and programming subject to change. FINANCIAL AID APPLICATION FORM Berkeley Rep School of Theatre is pleased to be able to offer financial aid for its 2006/07 classes. Scholarships will be granted to students attending classes who demonstrate a strong financial need. Financial aid will be disbursed on a sliding scale—eligible families generally receive scholarships covering between 30%–80% of tuition. Families applying for financial aid must submit a minimum $25.00 deposit per student at the time of registration. This amount secures the student’s place in the program while their financial aid application is under consideration. This deposit is refundable if the registration is cancelled by the end of the first week of class. To apply for financial aid: —Print and complete this application form. Please print clearly and be specific. —Include your deposit of $25.00/student. —Attach a SIGNED copy of your 2005 Federal Income Tax Returns. —Applications should be mailed to: Berkeley Rep School of Theatre / Nevo Education Center / 2025 Addison Street / Berkeley, CA 94704. The financial aid application is not your registration. If you have not already registered, please be sure to include the registration form along with your financial aid application. Any further questions? Please call us at 510.647.2972. STUDENT NAME DATE OF BIRTH REGISTERED FOR (name of class) ADDRESS FOR ALL CORRESPONDENCE CITY, STATE, ZIP PARENT / STEPPARENT / GUARDIAN 1 (at this address) PHONE (day) PHONE (evening) E-MAIL MONTHLY EARNINGS (before taxes) OCCUPATION / EMPLOYER PARENT / STEPPARENT / GUARDIAN 2 (at this address) PHONE (day) PHONE (evening) E-MAIL MONTHLY EARNINGS (before taxes) OCCUPATION / EMPLOYER ADDITIONAL MONTHLY HOUSEHOLD INCOME (include ALL sources: alimony or support from non-custodial parent, veteran/social security benefits, unemployment or workers’ compensation, federal or state aid, etc…) AVERAGE MONTHLY HOUSEHOLD EXPENSES (rent, utilities, groceries etc…) AMOUNT OF AID REQUESTED Please attach a SIGNED copy of your 2005 Federal Income Tax Returns. It is not necessary to include schedules. You may, but are not required, to list any extenuating circumstances regarding your financial situation on a separate page. My signature verifies the above statements to be true. PARENT / GUARDIAN SIGNATURE DATE