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WCP/BHCT Class Registration Form
Visit
http://www.wcpbhct.org/take-classes
for the current list of classes.
Need more information? Please contact us at 319.235.0367 or
info@wcpbhct.org
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* Required
Participant's First Name
*
Your answer
Participant's Last Name
*
Your answer
Participant's Age
*
Your answer
Parent's Name
(if participant is 18 years old or younger)
Your answer
Email address
*
Your answer
Phone
*
include area code, ex. 319-235-0367
Your answer
The phone number provided above is my
*
Home phone
Work phone
Mobile phone
Other:
Street address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Class Title
*
Your answer
Session Dates
*
Your answer
List any special accommodations or assistance you need in order to participate in this class
Your answer
Is the participant a current season ticket "member"?
*
Yes
No
I would like more information about season ticket memberships
Payment Arrangements (payment is due 1 week before class begins)
*
Please call me so that I can provide credit card information
I am mailing a check to: WCP/BHCT | 224 Commercial St. | Waterloo, IA 50701
I will stop by to make payment. (Office is located at 224 Commercial Street in Waterloo. Hours are Tuesday-Friday, 8 AM - 6 PM)
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This form was created inside of Waterloo Community Playhouse/Black Hawk Children's Theatre.
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