2019-2020 Acting Master Registration Form
2450 Grand Blvd., Ste. 144
Kansas City, MO 64108
Register by phone: 816.474.4241
STUDENT INFORMATION (One student per form)
Birth Date (mm/dd/yyyy)
Student (NOT Parent) Email Address
Student (NOT Parent) Cell Number
Allergies and/or Special Needs
2019-2020 School Name
Relationship to Student
Enter again to confirm
Cell Phone (use dashes XXX-XXX-XXXX)
Landline [Home] Phone (use dashes)
Work Phone (use dashes)
Place of Employment
I authorize the program directors to arrange emergency treatment by qualified personnel for my child
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.
EMERGENCY - First Person Teacher Should Call (Parent? Other?)
Contact Parent/Legal Guardian (listed above)
Yes - Call CELL first
Yes - Call LANDLINE first
NO - Call "Other" listed below
Other Emergency Contact (Not Required)
Relation to Student(s)
Phone Number (use dashes)
ACTING MASTER CLASS SESSIONS
There is a class size limit for each time slot and classes do fill. Register early to secure a spot!
A full refund will be provided with notice at least TWO WEEKS prior to the class start date.
Registration for Session 2 is now closed. We hope to see you in Session 3.
SESSION 3: EXPERIENCING METHODOLOGIES
Hold April 12 for potential make-up snow date
Experiencing Methodologies | Sundays | 2/02-4/05 | 1:00-3:00pm | REGISTRATION CLOSED
Experiencing Methodologies | Sundays | 2/02-4/05 | 4:00-6:00pm | CLASS FULL-CALL 816-474-4241 FOR WAIT LIST
Experiencing Methodologies | Sundays | 2/02-4/05 | 6:00-8:00pm | REGISTRATION CLOSED-CALL 816-474-4241 FOR WAIT LIST
DISCOUNT - 10% Multi-Class
Discounts can not be combined
First time Donor = 20%
I am a current Coterie Donor (donated $100 or more within last calendar year) = 20% Discount
Renew my Coterie donation at the level below = 20%
10% Discount on Second or Third 2019-2020 ACTING MASTER Class
New OR Renewing Donors
- Donation discount applies to
For information about giving level benefits click
or contact Shannon King at (816) 994-8838.
Builder Level ($100)
Sustainer Level ($500)
No, Thank You
Innovator Level ($1000)
Visionary Level ($5000)
Please contact me. Not sure of my current membership
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.
Name on Card
Credit Card Type
Credit Card Number
Expiration Date (mm/yy)
3 Digit Code