Musical Theatre Institute
Your Broadway Connection
            Musical Theatre Institute Registration
                   for Events, dates TBA


Name of camper____________________________________________
Age____Grade____Performing Experience? Y N  (List on back)


Parent 1 Name____________________________________
Parent 1 Phone____________________________________

Parent 2 Name_____________________________________
Parent 2 Phone_____________________________________


Camper's T-shirt size _______________________

Emergency Contact___________________________________
Relationship to camper_________________________________
Phone Number________________________________________


Food Allergies/Medical concerns_____________________________________________

Minimum $150 deposit (non-refundable) to hold space

$150 deposit is non-refundable ________________Parent initial
No refunds after 2nd day_____________________Parent initial
Broadway Prep, tuition $________Parent initial
Wonder Years,   tuition $________Parent initial

Sibling discount: First child at full price, siblings receive $100 off.
Refer us to someone who registers, receive $50 off your tuition!

In consideration of your accepting this registration, I hereby for myself, my child, my heirs, executors and administrators, waive and release any and all claims for damages I or my child may have against John Wilkerson's Musical Theatre Institute and/or First Baptist Church, Farmers Branch, it's representatives, successors and assigns for any and all injuries suffered by myself or my child at the MusicalTheatre Summer Camp.

Parent/Guardian Signature__________________________________Date_________

Send registration form and payment to John Wilkerson, MTI
13060 Glenside Drive, Farmers Branch, TX 75234

For more information, please call 469-522-0766
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