Piper Summer 2024 Registration

Student Information

Student Name*

First Last

Please enter YOUR CHILD’S NAME as you wish it to appear in the playbill.

Student Pronouns (optional)

Select your child's preference from the dropdown menu.*

While preferences for workshops are considered, placement in a particular company is NOT guaranteed. STARLINGS ONLY: If you select multiple workshops, you will receive a follow-up email to select the specific combination.

Date of Birth*

Grade as of Fall 2024*

School as of Fall 2024*

Home Address*

Street Address City State ZIP Code

Student Home Phone*

Student Cell (if applicable)

T-Shirt Size*

In accordance with New York State Department of Health’s recommendations, we require that all families submit proof of MMR (Measles Mumps Rubella) vaccination. In addition, all participating children will need to show proof of COVID vaccination.*

Select All
My child has been vaccinated against MMR (REQUIRED)
My child has been vaccinated against COVID-19 (REQUIRED)

Email proof of vaccinatios to info@pipertheatre.org or mail to Piper Theatre Productions, PO Box 150613, Brooklyn, NY 11215. Waivers of Liability as related to Covid-19 will be sent to families electronically for review and signature.

My child has the following activity or medical restrictions. Please elaborate so that we may better meet your child's needs.

Behavior Policy*

By participating in Piper Theatre’s Programs, you agree to the terms of the Behavior Policy. Piper is committed to ensuring that all participants who attend are provided an atmosphere in which they can learn together free from harassment or intimidation. Fun and safety are only possible when all participants agree to work collaboratively. You and your child are advised to inform any member of the staff about any conduct that is offensive or is in contradiction to our commitment to a harassment-free environment. All participants are expected to show respect for lead teachers, teaching assistants, fellow students, staff, guests and facilities. Disruptive or dangerous behaviors and physical aggression are not acceptable. Our teaching artists are professionals who use sound, positive management tools within their classes. If any participant does not respond to these measures, the participant will be escorted to the office for a time out. If the problem behavior persists, we will communicate with the parents or guardians and the participant may be removed from the program with no refund of program fees.

I have read and agree to the Behavior Policy

Parent/Guardian Information

It is important that we are able to contact you. Please be sure to include all relevant phone numbers.

Parent/Guardian Name*

Parent/Guardian Email*

Parent/Guardian Cell Phone*

Parent/Guardian Additional Phone (if applicable)

Parent/Guardian 2 (if applicable)

Parent/Guardian 2 Email (if applicable)

Parent/Guardian 2 Cell (if applicable)

Parent/Guardian 2 Additional Phone (if applicable)

Additional Contact

Please include a contact OTHER THAN family members already listed. Do not include Parents already listed above.

Emergency Contact Name/Relationship to Student*

Emergency Contact Best Phone*

Please tell us how you learned of Piper's summer programs (optional)

Permissions

Release and Waiver of Liability*

While participating in activities at Piper, each student is assumed to be voluntarily performing activities for which he/she assumes all risk, consequences and potential liability. I hereby release and hold harmless Piper Theatre Productions and the Old Stone House of Brooklyn and its agent or agents from any and all claims arising or resulting directly or indirectly from participation in Piper Theatre activities. I authorize Piper Theatre Productions to take necessary action in case of emergency if I am unable to be reached. In addition, I authorize Piper Theatre Productions and the Old Stone House to use photographs and/or recorded video in which my child appears in promotional literature, ads, displays or any format representing the program.

I agree to Waiver

My child has permission to attend any and all program field trips*

Yes
No

You will be notified in advance of any field trips.

My child has permission to leave independently after the program each day*

Yes
No

Early Drop-Off (8-9am) and/or Aftercare (4:00-6:00 pm)

I am interested.

Registration for Early Drop-Off and Aftercare may be available on a weekly basis subject to community interest.

Payment Information

A nonrefundable deposit is due upon registration. Full payment is due by May 15. Deposit is waived for financial aid applicants, pending awards.

I will make payment by the following method:*

Select payment method from the dropdown menu.

I'd like to apply for financial aid.

Yes

An application will be emailed to you separately. The DEADLINE for applications is April 15, Please submit as early as possible. Deposit is waived pending announcement of financial aid awards.

Name

This field is for validation purposes and should be left unchanged.

Registration 2024 Summer

Student Information

Parent/Guardian Information

Additional Contact

Permissions

Payment Information