Andy's Summer Playhouse · The Digital Renaissance Project Enrollment Form

Welcome to

Andy's Summer Playhouse!

We're looking forward to working with you in The Digital Renaissance Project! To enroll, you must be between 8 and 18 years old, and a parent or guardian needs to acknowledge that you will be participating.

There is a one-time registration fee of $50, which gives you total access to all activities in the Project. We understand that this is an unusual time for many families, so if you need help covering the fee, we can help! Please complete the registration form and follow the instructions in the payment section.

If you have additional questions, email us at info@andyssummerplayhouse.org.

Participant Information

Name *

First Name

Last Name

Email *

Verify Email *

Phone *

Date of Birth *

(mm/dd/yyyy)

School currently attending *

Grade entering in Fall 2020

If you have been an Andy's Kid in other years, what was the first year you joined?

Enter the year you started at Andy's.

Please let us know how you heard about us!

Add a second participant?

Do you want to enroll another participant with the same home address? You may enroll up to three participants at a time.

Yes

Participant #2 Information

Name (#2) *

First Name

Last Name

Email (#2) *

Verify Email *

Phone (#2)

Date of Birth (#2) *

(mm/dd/yyyy)

School currently attending (#2)

Grade entering in Fall 2020 (#2)

If you have been an Andy's Kid in other years, what was the first year you joined?

Enter the year you started at Andy's.

Add a third participant?

Do you want to add another participant with the same home address?

Yes

Participant #3 Information

Name (#3) *

First Name

Last Name

Email (#3) *

Verify Email *

Phone (#3)

Date of Birth (#3) *

(mm/dd/yyyy)

School currently attending (#3)

Grade entering in Fall 2020 (#3)

If you have been an Andy's Kid in other years, what was the first year you joined?

Enter the year you started at Andy's.

Family Information

Please provide name and contact information for at least one parent or guardian living with all the youth enrolled on this form.

Name of Parent/Guardian *

First Name

Last Name

Employer

Job Title

Email *

Verify Email *

Phone *

Home Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Have you ever been part of Andy's community?

I was an Andy's Kid!

Parent/guardian of Andy's Kid

Attended shows

Attended events

Andy's staff/artist

Donor

Name of Parent/Guardian #2

First Name

Last Name

Employer #2

Job Title #2

Email #2

Verify Email

Phone #2

Different home address?

Do you need to enter a different home address for Parent/Guardian #2?

Yes

Home Address for Parent/Guardian #2

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Have you ever been part of Andy's community? (#2)

I was an Andy's Kid!

Parent/guardian of Andy's Kid

Attended shows

Attended events

Andy's staff/artist

Donor

Emergency Contact *

Please provide up to three names and phone numbers to be contacted in the case of emergency.

Parent/Guardian Acknowledgement

By initialing below, I acknowledge that I am enrolling all of the children listed on this form in Andy's Summer Playhouse 2020 program, The Digital Renaissance Project. I understand that there is an enrollment fee of $50 per child due at the time of registration. If I am unable to pay the fee at this time, I will contact Andy's using the comment box on this form.

I approve enrollment for the youth listed above. (Initial below) *

Photo/Video Release

By initialing below, I hereby grant Andy’s Summer Playhouse permission to take photographs and videos of all participant(s) named on this form. I acknowledge that these photos and videos will be used for promotional purposes and will be made available online to the public through The Digital Renaissance Project.

If I do not grant permission by initialing below, I understand that the child/children that are enrolled through this form will only be able to partipate in a limited number of activities that do not involve recording the children's activities.

Photo/Video Release *

Yes, release granted (please initial in the box)

Not granted

Photo/Video release granted (initial here)

Calculate the Enrollment Fee

The cost to enroll is $50 for each youth/teen. If you are a CAST Team member, do NOT check the payment box below. Instead, use the comments box to let us know that you are a CAST Team member. If you requesting assistance to cover the registration fee, do NOT check the payment box. Instead, use the comments box to help us understand your financial situation.

Calculate the Enrollment Fee	Quantity
$50 - per child

Explanation of non-payment *

General Comments or Questions

Add 3% to my total amount to help cover the payment processing fees