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SUMMER 2017 YAC MIDDLE SCHOOL APPLICATION
DATES: AUGUST 7 - 11, 2017 (9AM- 5PM MONDAY THROUGH FRIDAY)
$399 TUITION FEE
Please fill out the following form, and submit headshot and personal statement to
mwalsh@stagestheatre.com
.
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$15 (Early Drop-off fee for the week)
$95 (Late Stay fee for the week)
STUDENT FIRST NAME
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Your answer
STUDENT LAST NAME
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Your answer
PARENT/GUARDIAN NAME
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Your answer
STUDENT AGE
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Your answer
BIRTHDAY (mm/dd/year)
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SCHOOL (AS OF FALL '17)
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Your answer
GRADE
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STREET ADDRESS
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CITY
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STATE
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ZIP
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Your answer
HOME PHONE
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PARENT PHONE
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Your answer
STUDENT E-MAIL
Your answer
PARENT E-MAIL
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WHY DO YOU WANT TO ATTEND YAC?
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FORM OF PAYMENT ($399)
Cash
Check
Credit (see below)
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NAME ON CARD
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CARD NUMBER
Your answer
EXPIRATION DATE
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BILLING ZIP CODE
Your answer
SEND CASH OR CHECK PAYMENT TO:
Mitchell Greco, Artistic Associate
Stages Repertory Theatre
3201 Allen Parkway
Suite 101
Houston, TX 77019
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