The Coterie

2024 Summer Class Registration Form

THE COTERIE
2450 Grand Blvd., Ste. 144
Kansas City, MO 64108
www.thecoterie.org
Register by phone: 816.994.8832

To register for Coterie classes at PEMBROKE HILL CLICK HERE

To register for Coterie classes at KCKCC CLICK HERE

Student Information (One student per form)

*Designates required fields

First Name *

Last Name *

Birth Date (mm/dd/yyyy) * +

Preferred name in class, if different from above:

Pronouns: *

She/Her

He/Him

They/Them They/Them

2024-2025 Grade *

2024-2025 School Name or Homeschool *

Allergies and/or Special Needs *

None	Other Other

My child would like to be in the same class as friend named:

Parent/Legal Guardian

First Name *

Last Name *

Relationship to Student *

Email Address *

Enter again to confirm *

Street Address *

City *

State *

Zip Code *

Cell Phone (use dashes XXX-XXX-XXXX) *

Landline [Home] Phone (use dashes)

Work Phone (use dashes) 🛈

Employer Name/Self Employed/
Stay At Home Parent * 🛈

I authorize the program directors to arrange emergency treatment for my child by qualified personnel. *

Yes

No

I authorize the use of my child's photograph in any future web or print advertisements and understand that my child's full name will NOT be used. *

Yes

No

Emergency Contacts

Primary Contact Parent/Legal Guardian (listed above) *

Yes - Call CELL first	Yes - Call LANDLINE first
Yes - Call WORK first	NO - Call "Other" listed below

Other Emergency Contact

First Name *

Last Name *

Relation to Student(s) *

Phone (use dashes XXX-XXX-XXXX) *

Phone Type *

Cell

Home Landline

Work

Mark Box for Class/Classes to Register (closed classes are noted)

Registration for classes are closed the Friday before class begins, at 4:00 PM.

If a class is marked FULL or 0 remaining: Cancellations do happen, and openings will show on this page when they occur.

To register for Coterie classes at PEMBROKE HILL CLICK HERE

To register for Coterie classes at KCKCC CLICK HERE

Miller-Marley at 10448 Mastin Street, Overland Park KS

Crown Center, 2401 Grand Boulevard, Kansas City MO

Entering Grades K-2nd: Imaginary Friend Adventures | June 24-28 at 9:00am-12:00pm (8 remaining)

Entering Grades K-2nd: Groovy Tales with Pete the Cat | July 22-26 at 9:00am-12:00pm (5 remaining)

Entering Grades 3rd-5th: Summer Term at Hogwarts | June 24-28 at 12:30pm-3:30pm (2 remaining)

Entering Grades 3rd-5th: Percy Jackson and the Mythological | July 22-26 at 12:30pm-3:30pm (5 remaining)

Entering Grades 3rd-5th: A World of Pure Imagination | July 8-12 at 9:00am-12:00pm (5 remaining)

Entering Grades 5th-7th: Audition Lab | July 8-12 at 12:30pm-3:30pm (11 remaining)

Entering Grades 5th-7th: Funny Bones: Intro to Improv | July 29-Aug 2 at 9:00am-12:00pm (12 remaining)

Entering Grades 8th-12th: Audition Lab | July 8-12 at 12:30pm-3:30pm (9 remaining)

Entering Grades 8th-12th: Comedy On Your Feet | July 29-Aug 2 at 12:30pm-3:30pm (9 remaining)

Liberty Community Center, 1600 S. Withers Road, Liberty MO

Current Total:

$0.00

Summer Camp T-Shirt - $10 each

A T-shirt is NOT required
Shirt distributed at check-in on the first day of class

Shirts are available as inventory allows.

Discounts - Available for any class registered through The Coterie (not available for Coterie @ Pembroke Hill)

NOTE: The multiple class and sibling discounts are available for Coterie classes in Overland Park, Liberty, and Crown Center. Although Coterie classes are also offered at Pembroke Hill, this location requires registration through www.pembrokehill.org and cannot honor the 10% Coterie discount.

Student in multiple Coterie 2024 Summer classes OR Siblings taking a Coterie Summer 2024 class = 10% Discount

NA

Refund Policy

The Coterie will provide a full refund if given notice two weeks before the first day of the class. Notification must be received two weeks before the first class day for a refund or to request a move to a different class. *

I have read the refund policy and understand that notice must be received two weeks before the first day of class for a refund or to request a move to a different class.

Payment

Current Total:

$0.00

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

3 Digit Code *

If using a Coterie Gift Card, please enter the card number/code below:

Total on Gift Card:

How Did You Hear About 2023 Summer Classes?

Check all that apply to this registration: *

Youth Small (size 6-8)	Youth Medium (size 10-12)	Youth Large (size 14-16)	Adult Small
Adult Medium	Adult Large	Adult XL	Adult 2XL
Adult 3XL

Took a Coterie class before	Information in Coterie lobby	Liberty Community Center brochure/website	Instagram	Other School flyer (paper or district website)
www.thecoterie.org	Coterie class brochure in mail	Miller-Marley flyer/website	Facebook	KC Parent magazine/KCParent.com
Coterie email	Kansas City Kansas Community College brochure	Pembroke Hill brochure/website	Word of mouth	KC Studio
Other Other