The Coterie
2023-2024 Acting Master Registration Form

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

*Required Information

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

Student (NOT Parent) Email Address

Student (NOT Parent) Cell Number

Allergies and/or Special Needs *

None	Other Other

2023-2024 Grade *

2023-2024 School 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) 🛈

Place of Employment * 🛈

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

Yes

No

Emergency Contact

First Emergency Contact (may be the same as Parent/Guardian Info)

First Name *

Last Name *

Relation to Student(s) *

Phone Number (use dashes) *

Phone Type *

Cell

Home Landline

Work

Second Emergency Contact

First Name *

Last Name *

Relation to Student(s) *

Phone Number (use dashes) *

Phone Type *

Cell

Home Landline

Work

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.

-Each class has a maximum of 12 students

SESSION 1: ADVANCED TECHNIQUES | Sundays, September 10th - October 15th

Advanced Techniques | 1:00-3:00pm | $110.00 (0 remaining)

Advanced Techniques | 3:30-5:30pm | $110.00 (0 remaining)

Advanced Techniques | 6:00-8:00pm | $110.00 (1 remaining)

SESSION 2: EXPLORING METHODOLOGIES | Sundays, October 22nd - December 10th
No class Thanksgiving weekend

Exploring Methodologies | 1:00-3:00pm | $170.00 (0 remaining)

Exploring Methodologies | 3:30-5:30pm | $170.00 (1 remaining)

Exploring Methodologies | 6:00-8:00pm | $170.00 (6 remaining)

*SESSION 3: SHOWCASE | Sundays, January 21st - March 24th
*Session 1 or Session 2 is a prerequisite to register for Session 3
Showcase performance will be April 7th; performance is mandatory for completion of this session.

Showcase | 1:00-3:00pm | $200 (1 remaining)

Showcase | 3:30-5:30pm | $200 (1 remaining)

Showcase | 6:00-8:00pm | $200 (7 remaining)

Current Total:

$0.00

ELIGABLE DISCOUNTS AND DONATION LEVELS (10% Multi-Class OR 20% Coterie Member)

New OR Renewing Donors - Donation discount applies to SCHOOL YEAR classes. For information about giving level benefits click HERE or contact Jonathan Thomas at (816) 994-8838.

Discounts can not be combined; your discount will be applied after you submit your registration.

First time Donor = 20% discount on all Coterie school-year classes

I am a current Coterie Donor (donated $100 or more within last calendar year) = 20% Discount on all Coterie school year classes

Renew my Coterie donation at the level below = 20% discount on all school-year Coterie classes

10% Discount on Second or Third 2023-2024 ACTING MASTER Class

N/A

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

*Please note if you have selected the "10% Discount" option above, this will not be reflected in the "Current Total" shown below. All registrations are processed manually by the Booking Coordinator, and the discount will be reflected in the amount charged to your card.

Current Total (before discounts):

$0.00

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mmyy) *

3 Digit Code *

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