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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STUDENT FIRST NAME *
STUDENT LAST NAME *
PARENT/GUARDIAN NAME *
STUDENT AGE *
BIRTHDAY (mm/dd/year) *
SCHOOL (AS OF FALL '17) *
GRADE *
STREET ADDRESS *
CITY *
STATE *
ZIP *
HOME PHONE *
PARENT PHONE *
STUDENT E-MAIL
PARENT E-MAIL *
WHY DO YOU WANT TO ATTEND YAC? *
FORM OF PAYMENT ($399)
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NAME ON CARD
CARD NUMBER
EXPIRATION DATE
BILLING ZIP CODE
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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