The Coterie

2021 Summer Class Registration Form

THE COTERIE
2450 Grand Blvd., Ste. 144
Kansas City, MO 64108
www.thecoterie.org
Register by phone: 816.474.4241

To register for Coterie classes at PEMBROKE HILL CLICK HERE
Registration for classes at Pembroke Hill closes 5/21 - PLAN AHEAD!

Student Information (One student per form)

*Designates required fields

First Name *

Last Name *

Gender *

Birth Date (mm/dd/yyyy) * +

2021-2022 Grade *

2021-2022 School Name or Homeschool *

Allergies and/or Special Needs *

None	Other Other

Student (NOT Parent) Cell Number

Student (NOT Parent) Email Address

My child would like to be in the same class as his/her friend:

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 or
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 - Who is the FIRST Person Teacher Should Call (Parent? Other?)

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 (Not Required)

First Name

Last Name

Relation to Student(s)

Phone (use dashes XXX-XXX-XXXX)

Cell

Home Landline

Work

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

To register for Coterie classes at PEMBROKE HILL CLICK HERE

VR = Virtual Class using Zoom

Times listed are CDT - Central Daylight Time

VR | The Floor Is Lava! Scene Adventures | Entering Grades 3-5 | July 5-9 | 12:30-3:30pm | $125

VR | Welcome To Musical Theatre | Entering Grades 5-10 | July 12-16 | 12:30-3:30pm | $145

VR | Musical Theatre: Triple Threat | Entering Grades 6-12 | July 26-30 | 12:30-3:30pm | $145

OP = Miller-Marley at 10448 Mastin Street, Overland Park KS

CC = Crown Center, 2401 Grand Boulevard, Kansas City MO

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

Current Total:

$0.00

PEM = Pembroke Hill Lower Campus, 400 W. 51st Street, KCMO

The entire Pembroke Hill summer class catalog, including Covid protocols and fees, can be found at www.pembrokehill.org starting 4/1

To register for Coterie classes at Pembroke Hill CLICK HERE

Registration for classes at Pembroke Hill closes 5/21 - PLAN AHEAD!

PEM | Everyone Loves Tacos (And Dragons!) | Entering Grades 1-2 | June 7-11 | 12:30-3:30pm | $175

PEM | The Adventures Of Peppa Pig & Friends | Entering Grades 1-2 | 1-2 | June 14-18 | 12:30-3:30pm | $175

PEM | Funny Bones: Intro To Improv | Entering Grades 6-8 | June 28-July 2 | 12:30-3:30pm | $190

PEM | Comedy On Your Feet | Entering Grades 9-12 | June 28-July 2 | 12:30-3:30pm | $190

PEM | Summer Term At Hogwarts | Entering Grades 3-5 | July 12-16 | 12:30-3:30pm | $175

PEM | We Built This City | Entering Grades 1-2 | July 19-23 | 12:30-3:30pm | $175

PEM | Audition Lab | Entering Grades 6-8 | July 26-30 | 12:30-3:30pm | $190

PEM | Audition Lab | Entering Grades 9-12 | July 26-30 | 12:30-3:30pm | $190

Summer Camp T-Shirt - $10 each

A T-shirt is NOT required
-IN-PERSON class: Shirt distributed at check-in on the first day of class
-VIRTUAL class: Shirt mailed at our actual USPS cost charged to same credit card as registration OR pick up at Coterie box office
-Call 816-474-4241 for Adult 2X and 3X ($12)

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, Crown Center and our Virtual options. Although Coterie classes are also offered at Pembroke Hill, this location requires registration through www.pembrokehill.org can not honor the 10% Coterie discount.

Student in multiple Coterie 2021 Summer classes OR Siblings taking a Coterie Summer 2021 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 *

How Did You Hear About 2021 Summer Classes?

Check all that apply to this registration: *

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