Registration Form

REGISTRATION FORM

IMPORTANT! If you are signing up multiple children, please submit a separate form for each one.
Payment via cash or cheque accepted on the first day of class.

* Indicates required field

Which program is the participant signing up for? *

A Play In A Day - PA Day program Journey of the Noble Gnarble - After School program Intro to the Theatre - After School program Arabian Nights - March Break program

PARTICIPANT'S INFORMATION

Participant's Name *

First

Last

Participant's Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Participant's Date of Birth *

Participant's Age (as of Dec 31) *

Does the participant have any allergies or medical conditions that we should be aware of prior to classes? *

PARENT/LEGAL GUARDIAN'S INFORMATION

Parent/Guardian's Name *

First

Last

Parent/Guardian's Email *

Parent/Guardian's Phone Number *

Parent/Guardian's Cell Phone Number *

EMERGENCY CONTACT INFORMATION

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Comments/Questions *

Submit

REGISTRATION FORM

CLASSES & CAMPS

PRISM Theatre in the Park

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