The Coterie

2024 Summer Class Registration Form

Site: Kansas City Kansas Community College

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)

*Designates required fields

First Name *

Last Name *

Pronouns: *

she/her

he/him

they/them they/them

Preferred Name In Class (if different from above)

Birth Date (mm/dd/yyyy) * +

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

My student is a resident of Wyandotte County *

Yes

No

*For non-Wyandotte resesidents all half-day classes are $170 and our full-day class is $550.

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

Second Emergency Contact

First Name *

Last Name *

Relation to Student(s) *

Phone (use dashes XXX-XXX-XXXX) *

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.

Kansas City Kansas Community College, 7250 State Ave, Kansas City KS (Performing Arts Center)
*all half-day classes are $170 for non-Wyandotte residents; Out Loud: Create Your Own Play is $550 for non-Wyandotte residents

Entering Grades K-2nd: Imaginary Friend Adventures | June 17 - 21 at 9:00am-12:00pm (1 remaining)

Entering Grades 3rd-5th: Summer Term at Hogwarts | June 17 - 21 at 12:30pm-3:30pm (3 remaining)

Entering Grades 5th-7th: Audition Lab | June 10 - 14 at 12:30pm-3:30pm (7 remaining)

Entering Grades 8th-12th: Audition Lab | June 10 - 14 at 12:30pm-3:30pm (11 remaining)

Entering Grades 6th-12th: Out Loud: Create Your Own Play | June 17-28 at 9:00am-3:30pm; Performs June 28th at 7:00pm & June 29th at 2:00pm (0 remaining)

Learning Club Registration (0 remaining)

Summer Camp T-Shirt - $10 each

A t-shirt is NOT required. Shirts will be distributed at check-in on the first day of class

Cancellation Policy

The Coterie requests notification at least two weeks before the first class day if a student must cancel. *

I have read the cancellation policy and understand that notice is expected at least two weeks before the first day of class if a student must cancel.

Payment Information (only needed if purchasing a class and/or t-shirt)

Name On Card *

Credit Card # *

Exp. Date *

CVV *

How Did You Hear About 2024 Summer Classes?

Check all that apply to this registration: *

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

Took A Coterie Class Before	Information In Coterie Lobby	Instagram	Other School flyer (paper or district website)
www.thecoterie.org	Coterie Class Brochure In Mail	Facebook	KC Parent Magazine/KCParent.com
Coterie email	Kansas City Kansas Community College brochure/website	Word of mouth	KC Studio
Other Other