The Coterie

2023-2024 Class Registration Form

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

Student Information (One student per form)

First Name *

Last Name *

Birth Date (mm/dd/yyyy) * +

Pronouns: *

she/her/hers

he/him/his

they/them/theirs

other other

Preferred name in class, if different from above

2023-2024 Age/Grade *

School Name or Home School *

Allergies and/or Special Needs/Accommodations *

None	Other Other

My child would like to be in the same class as (friend's name):

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 by qualified personnel for my child *

Yes

No

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

Yes

No

Emergency Contact

Primary Contact Parent/Legal Guardian (listed above) *

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

Second Emergency Contact

First Name *

Last Name *

Relation to Student *

Phone Number (use dashes) *

Phone Type *

Cell

Home Landline

Work

Check Class(es) to Register

PLEASE NOTE:

Coterie classes are by the student's current grade and not by age. If a child is 5, but not currently participating in a 2023-2024 kindergarten class at school, the Early Childhood classes are appropriate. If a child is in kindergarten, they should enroll in the K-1st grade class.

PARENTS: A student must CURRENTLY be in the grade listed, regardless of age, in order to register for the class.

FALL - Crown Center, KCMO
*Classes will NOT be held on Halloween, Tuesday October 31st. These classes will end on November 14th instead of the 7th.

Ages 3-5: Playtime with Bluey | Saturdays Oct 7 - Nov 11 at 10:30am-11:30am (0 remaining)

Grades K - 1st: WHAM! KAPOW! Superheroes NOW! | Tuesdays Oct 3 - Nov 14* at 5:30-7:00 (0 remaining)

Grades 2nd - 4th: Monsterologists | Mondays Oct 2 - Nov 6 at 5:30-7:00 (0 remaining)

Grades 4th - 6th: Secret Identities and Cryptic Messages | Tuesdays Oct 3 - Nov 14* at 5:30-7:00 (0 remaining)

Grades 5th - 6th: Scene Study: Scenes of Horror and Fright | Wednesdays Oct 4 - Nov 8 at 5:30-7:00 (0 remaining)

Grades 7th - 10th: Scene Study: Scenes of Horror and Fright | Wednesdays Oct 4 - Nov 8 at 5:30-7:00 (0 remaining)

FALL - Miller Marley School of Dance and Voice, Overland Park

Grades K - 1st: WHAM! KAPOW! Superheroes NOW! | Saturdays Oct 7- Nov 11 at 12:00pm-1:30pm (0 remaining)

Grades 2nd - 4th: Monsterologists | Saturdays Oct 7- Nov 11 at 2:00pm-3:30 (1 remaining)

Grades 4th - 6th: Secret Identities and Cryptic Messages | Saturdays Oct 7 - Nov 11 at 12:00pm-1:30pm (0 remaining)

Grades 5th - 10th: Scene Study: Scenes of Horror and Fright | Saturdays Oct 7 - Nov 11 at 2:00pm-3:30pm (0 remaining)

WINTER - Crown Center, KCMO

Ages 3-5: Storybook Magic | Saturdays Jan 27 - Mar 2 at 9:00am-10:00am (5 remaining)

Ages 3-5: Storybook Magic | Saturdays Jan 27 - Mar 2 at 10:30am-11:30am (0 remaining)

Grades K - 1st: Colorful Characters | Tuesdays Jan 31 - Mar 5 at 5:30pm-7:00pm (4 remaining)

Grades 2nd - 4th: Daydream Adventures | Mondays Jan 29 - Mar 4 at 5:30pm-7:00pm (1 remaining)

Grades 4th -- 6th: Percy Jackson at Camp Half-Blood | Tuesdays Jan 31 - Mar 5 at 5:30pm-7:00pm (0 remaining)

Grades 5th - 7th: Theatre Artist Toolkit | Wednesdays Jan 31- Mar 6 at 5:30pm-7:00pm (4 remaining)

Grades 8th - 12th: Theatre Artist Toolkit | Wednesdays Jan 31- Mar 6 at 5:30pm-7:00pm (6 remaining)

WINTER- Miller Marley School of Dance and Voice, Overland Park

Grades K - 1st: Colorful Characters | Saturdays Jan 27 - Mar 2 at 12:00pm-1:30pm (9 remaining)

Grades 2nd - 4th: Daydream Adventures| Saturdays Jan 27 - Mar 2 at 2:00pm-3:30pm (3 remaining)

Grades 4th - 6th: Percy Jackson at Camp Half-Blood | Saturdays Jan 27 - Mar 2 at 12pm-1:30 (0 remaining)

Grades 5th - 7th: Theatre Artist Toolkit | Saturdays Jan 27 - Mar 2 at 2pm-3:30 (7 remaining)

Grades 8th - 12th: Theatre Artist Toolkit | Saturdays Jan 27 - Mar 2 at 2pm-3:30 (9 remaining)

SPRING - Crown Center, KCMO

Ages 3-5: Bugs and Butterflies | Saturdays Mar 30 - May 4 at 10:30am-11:30am (0 remaining)

Grades K - 1st: Mole Rat Mania with Mo Willems | Tuesdays Apr 2 - May 7 at 5:30pm-7:00pm (8 remaining)

Grades 2nd - 4th: Invention Convention | Mondays Apr 1 - May 6 at 5:30pm-7:00pm (5 remaining)

Grades 4th -- 6th: Outta Your Head | Tuesdays Apr 2 - May 7 at 5:30pm-7:00pm (2 remaining)

Grades 5th - 7th: Audition Lab | Wednesdays Apr 3 - May 8 at 5:30pm-7:00pm (5 remaining)

Grades 8th - 12th: Audition Lab | Wednesdays Apr 3 - May 8 at 5:30pm-7:00pm (7 remaining)

SPRING - Miller Marley School of Dance and Voice, Overland Park

Grades K - 1st: Mole Rat Mania with Mo Willems | Saturdays Mar 30 - May 4 at 12:00pm-1:30pm (8 remaining)

Grades 2nd - 4th: Invention Convention | Saturdays Mar 30 - May 4 at 2:00pm-3:30pm (9 remaining)

Grades 4th - 6th: Outta Your Head | Saturdays Mar 30 - May 4 at 12:00pm-1:30pm (7 remaining)

Grades 5th - 7th: Audition Lab | Saturdays Mar 30 - May 4 at 2:00pm-3:30pm (11 remaining)

Grades 8th - 12th: Audition Lab | Saturdays Mar 30 - May 4 at 2:00pm-3:30pm (11 remaining)

Current Total:

$0.00

Gift Certificate - Complete ONLY if this class is a gift

What should appear on the "TO" line of the Gift Certificate?

What should appear on the "FROM" line of the Gift Certificate?

Where should the GIFT CERTIFICATE be mailed? (complete street address, city, state, zip code)

Discounts & Donation Levels

Discounts can not be combined

20% Discount - Please make me a NEW Coterie Donor at the rate below (20% off all SCHOOL YEAR classes taking place during the next calendar year from donation date)

20% Discount - I am a CURRENT Coterie Donor (donated $100 or more within last calendar year)

20% Discount - RENEW my membership at the rate below (20% off all SCHOOL YEAR classes taking place during the next calendar year from donation date)

10% Discount - Took 2023 Summer Class (June or July of 2023) at Crown Center, Overland Park, Liberty, or Pembroke Hill

N/A

Donation Levels - For information about giving level benefits contact Jonathan Thomas at 816-994-8838.

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 - Required at time of registration

Current Total:

$0.00

Name on Card *

Credit Card Type *

Credit Card # *

Expiration Date (mmyy)

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 Our Classes?

Check all that apply *

Builder Level ($100)	Sustainer Level ($500)	No, thank you
Innovator Level ($1000)	Visionary Level ($5000)	Please contact me. Not sure of my current membership

Miller Marley flyer or website	Word of mouth	The Coterie website	Received Coterie class brochure in mail
Received Coterie email	Coterie play program	Information in Coterie lobby	Took a Coterie class before
KC Parent Magazine	School District Email System	Facebook	Instagram
Other (if Other, complete field) Other (if Other, complete field)