Registration
3 openings left in this event!
Already a customer? Click here to login.
Broadway Master Class with one of the stars from the Broadway show Cabaret ~ Ages 9 & up / Level: Int to Advanced ~ $20 Academy Members / $25 Non-Academy Members ~ Please Note: If you enter a different credit card than that which is on file, the system will automatically change your card on file to the one you are providing. Please go to your portal and make sure the card on file is the one you wish to use.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-Freshman
college-Junior
college-Senior
college-Sophomore
Kindergarten
Pre-K3
Pre-K4
preschool
Disabilities-please explain:
Allergies:
Medications-please explain:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-Freshman
college-Junior
college-Senior
college-Sophomore
Kindergarten
Pre-K3
Pre-K4
preschool
Disabilities-please explain:
Allergies:
Medications-please explain:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-Freshman
college-Junior
college-Senior
college-Sophomore
Kindergarten
Pre-K3
Pre-K4
preschool
Disabilities-please explain:
Allergies:
Medications-please explain:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-Freshman
college-Junior
college-Senior
college-Sophomore
Kindergarten
Pre-K3
Pre-K4
preschool
Disabilities-please explain:
Allergies:
Medications-please explain:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college
college-Freshman
college-Junior
college-Senior
college-Sophomore
Kindergarten
Pre-K3
Pre-K4
preschool
Disabilities-please explain:
Allergies:
Medications-please explain:
Questions/Options:
(checked=yes)
Additional Information:
Release of Liability
(Show-Hide Details)
As the legal parent or guardian, I hereby release and hold harmless Mary Jo's Performing Arts Academy, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or in route to or from any of said premises. I understand that appropriate physical contact is required during the instruction of dance, and I give permission for instructors to make appropriate physical contact with me or my child for such instruction.
I understand Mary Jo's Performing Arts Academy reserves the right to refuse my business without notice..
I've read the above and agree.
Video & Photo Release
(Show-Hide Details)
I understand and acknowledge that, from time to time throughout the year; my child may be photographed and/or videotaped while participating in functions involving MJPAA. I do hereby authorize Mary Jo's Performing Arts Academy to use these photographs and videotapes for the purposes of illustration, advertisement and publication in any manner whatsoever.
I've read the above and agree.
Assumption of Risk
(Show-Hide Details)
In case of emergency or sudden illness, I hereby give permission for a staff member of Mary Jo's Performing Arts Academy to authorize any physician, nurse practitioner, medical personnel or hospital to render immediate emergency aid as it might be required for the undersigned student's health and safety.
I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good physical and mental health.
It is required that all students be covered by their own family insurance and if injury occurs, it is understood that the students own policy is the only source of reimbursement.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
Please Wait...