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Do not forget to complete your purchase/sign-up once registration is completed.
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Password*

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Account Email*

How did you originally hear about Black Box Theatre Company?*

How?*

Who?

Primary Parent (or Registered User's) Information

First Name*

Last Name*

Street Address*

City*

State*

Zip*

Phone Number*

Billing Email Address*

Acknowledgments

Read the Black Box Theatre Company Code of Conduct

I have read and understand the Black Box Theatre Company Code of Conduct*

Refund Policy — Refund is 50% through the first week of rehearsals plus processing fee. After that no refunds will be issued.*

Media Release — By selecting "I Agree" below I grant permission for my child (or myself) to participate and appear in video or audio recordings, films, photographs, written articles, or on websites and social media sites for the purpose of promoting, showcasing, and/or sharing information about Black Box Theatre Co. ("BBTC") programs. This consent includes the use and editing of my child’s (or my) image, voice, and name in media projects and promotions by BBTC to print, broadcast, or Internet media outlets, such as newspapers, radio, and television stations. In consideration of the opportunity for my child (or myself) to participate, I release BBTC, including its employees, contractors, board members, volunteers, or other representatives from all claims resulting from the use and editing of my child’s (or my) image, voice, or name, and the release to media outlets.

General Liability Statement — By selecting "I Agree" below I, individually, and on behalf of my minor child (or children) and our respective heirs, successors, assigns and personal representatives, hereby release, acquit, and forever discharge Black Box Theatre Co., Inc. and their administration, staff, designated volunteers, agents, board members, officers, trustees, and representatives (in their official and individual capacities) from any and all liability whatsoever for any and all damages, losses, injuries, or illnesses, including death, to persons or property or both, including but not limited to any claims, demands, actions, causes of action, damages, costs, expenses and attorney’s fees, which arise out of, during, or in connection with my child’s (or children’s) participation in the aforementioned activities, including but not limited to any damages, losses, illnesses, or injuries to persons or property or both, which may be sustained or suffered by my child or any person in connection with my child’s (or children’s) association with, or participation in, activities at, sponsored by, or arising out of Black Box Theatre Co. Inc. activities. I agree that this Waiver, Release and Indemnification Agreement is intended to be as broad and inclusive as permitted by the laws of the state of Indiana and if any portion hereof is held invalid, it is agreed that the balance hereof shall, notwithstanding, continue in full legal force and effect. In signing this Waiver, Release and Indemnification Agreement, I hereby acknowledge and represent that I have read this entire document, that I understand its terms and provisions, that I understand it affects my legal rights and those of my child (or children), that it is a binding Agreement, and that I have signed it knowingly and voluntarily. If a serious illness or injury develops and immediate medical attention is necessary for my child/ren, and I am unable to be reached, I give permission for emergency treatments or surgery as recommended by a licensed attending physician.*

Act of God Statement — Participant acknowledges that acts of God, forces majeure, or any occurrences outside of the control of BBTC, including public health pandemics or outbreaks, that would prevent BBTC from continuing and/or completing production of the program for which participant is registering, will not entitle participant to a refund, and that payment of fees associated with registration is full and final payment for the program herein. BBTC reserves the right to decide whether a class, workshop, camp, production, or other BBTC sanctioned event should or should not continue based on any factors it deems relevant to the health and safety of its organization.*

Parent 2 Information

Or Spouse/Partner Information for adult participants.

Add Parent 2 Information?*

Parent 2 First Name*

Parent 2 Last Name*

Parent 2 Email*

Parent 2 Phone*

Emergency Contact Information

Non-Parental Emergency Contact is Required
Adult performers use emergency contact who does not reside in your household.

Emergency Contact Name*

Emergency Contact Phone*

Student Information

Adult performers also fill out "student" fields.

Student 1 First Name*

Student 1 Last Name*

Student 1 School*

Student 1 School (Other)*

Student 1 Current Grade*

Student 1 Medical Conditions/Allergies (If NA, put NA)*

Student 1 Other Comments/Concerns (If NA, put NA)*

Add Student 2 Information?*

Student 2 First Name*

Student 2 Last Name*

Student 2 School*

Student 2 School (Other)*

Student 2 Current Grade*

Student 2 Medical Conditions/Allergies (If NA, put NA)*

Student 2 Other Comments/Concerns (If NA, put NA)*

Add Student 3 Information?*

Student 3 First Name*

Student 3 Last Name*

Student 3 School*

Student 3 School (Other)*

Student 3 Current Grade*

Student 3 Medical Conditions/Allergies (If NA, put NA)*

Student 3 Other Comments/Concerns (If NA, put NA)*

Add Student 4 Information?*

Student 4 First Name*

Student 4 Last Name*

Student 4 School*

Student 4 School (Other)*

Student 4 Current Grade*

Student 4 Medical Conditions/Allergies (If NA, put NA)*

Student 4 Other Comments/Concerns (If NA, put NA)*

Add Student 5 Information?*

Student 5 First Name*

Student 5 Last Name*

Student 5 School*

Student 5 School (Other)*

Student 5 Current Grade*

Student 5 Medical Conditions/Allergies (If NA, put NA)*

Student 5 Other Comments/Concerns (If NA, put NA)*

About

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Get In Touch

(765) 444-2282

About

Profile

Get In Touch

(765) 444-2282

Acknowledgments

Parent 2 Information

Emergency Contact Information

Student Information

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