SHINE on STAGE at Ka’ohao School Registration Kaohao Shine on Stage Registration 3rd Trimester Please Fill Out The Registration Form Below! Classes will meet Wednesday afternoons. K-2 Grade 1:15-2:15pm and 3-6 Grade 2:15-3:15pm Student Name(Required) First Last Grade(Required) Teacher and Class Room(Required) Is your child enrolled in A+?(Required) Yes No Any health concerns we should know about? Parent/Guardian Name(Required) First Last Parent/Guardian Phone(Required)Parent/Guardian Email(Required) Enter Email Confirm Email Shine on Stage Classes(Required) K-2 Grade Class 3-6 Grade Class Total PAYMENT OPTIONS(Required) Venmo Credit Card VENMO me @Sarah-Halford *please provide student's name in memo *please note if Venmo is not received for class then spot is not guaranteed or held Credit Card(Required)Card Details Cardholder Name Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent(Required) I agree to the privacy policy.I hereby give Shine on Stage and Sarah Souza the permission to use my child’s photograph publicly to promote the Shine on Stage Performing Arts Program and Shine Acting Studio. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. I agree to allow my student to be in photos. Liability- I allow my student to participate in classes and do herby release, forever discharge and agree to hold harmless Shine on Stage, its owners, directors, employees, volunteers from any and all liability, claims or demands for accidental personal injury, expose to covid-19, sickness or death, as well as property damage and expenses, of any nature whatsoever which may incurred by the student while involved in the classes. Furthermore, I, on behalf of my minor student, herby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreational actives involved therein. LOOKING FORWARD TO SHINING WITH YOU! Δ