Young Movie Maker Pre-Registration Last Name: First Name: Middle Initial: Permanent Address: City: Province: Postal Code: D.O.B.: (m)(d)(yr)     Grade: Home Tel: Cell/Pager: Work: Email: Medical & Allergy Alert - Health Card #: Please list any medical or allergy information that we should know: Mother's Name: Email: Home Tel: Business Tel: Father's Name: Email: Home Tel: Business Tel: Have you previously taken an A.C.T. course? Yes / No How did you hear about A.C.T? PLEASE SELECT ONEFriendNewspaperWord of MouthArt's CourtE-mailInternet SearchWeb LinkO.S.S.D.Glebe OnlineOpen HouseOther If "Other", please specify: Why do you want to take this course? Please provide a brief summary of any relevant acting experience or training: ACT Permission & Photo Permission I give permission for to attend A.C.T. classes. In consideration of A.C.T. accepting the above mentioned minor as a participant of Acting in front of the Camera, we and each of us for ourselves and our heirs do voluntarily waive and release each and every right or claim for damages we and each of us have or may have against the school, its agents or representatives for any and all injuries or mishaps howsoever occasioned. I give permission for the use of photographs that may be taken during the workshop or other activities related to A.C.T. to be used by A.C.T. in brochures or for advertising and promotion for the school.  I understand that there will be no financial renumeration for the use of any photograph. Name of Parent/Guardian: Date: Young Movie Maker - Summer Camp July 21 - July 28, 2003 (10am - 6pm) + one day/evening to screen the finished project Unless otherwise notified, the workshop will take place at Arts Court, 2 Daly Avenue, Ottawa, ON (between Waller and Nicholas Streets, across from the Novotel Hotel and the Rideau Centre) Payment Options AI will send a current cheque of $499.00 for full payment. BI will send a cheque in the amount of $100.00 to reserve my spot, a cheque of $199.50 (dated no later than July 15, 2003), together with my cheque in the balance of $199.50 dated no later than July 20, 2003. Before you click the SUBMIT button below, please print this page and mail a copy with your cheque(s) payable to: A.C.T. Send your printed copy and cheque(s) to: A.C.T. 2 Daly Ave. Ottawa, Ontario K1N 6E2 Pre-Registration Forms will be held for one week. If no payment is received within 7 days, your Pre-Registration will become void. REFUND POLICY: If you are unable to attend due to illness, we will accept a medical letter no later than one week before the course begins.  A refund minus an administration fee will be given at that time. Please note that participating in this workshop does in no way guarantee talent representation or any performance related work to the participant.