2018 Youth Drama Saturdays: Winter Combat Intensive
Please complete one form per child.
Student's First Name *
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Student's Last Name *
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Student Gender *
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Student's Date of Birth *
Please enter the Month, Day and Year of the student's birth
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Current Grade *
School Attending *
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Street Address/Apt Number *
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City *
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State *
ZIP *
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Primary Adult first name *
Your answer
Primary Adult last name *
Your answer
Primary Adult relationship to student *
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Primary Adult address and apt. *
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Primary Adult city *
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Primary Adult state *
Primary Adult ZIP *
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Primary Adult, primary phone *
Your answer
Primary Adult, secondary phone
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Primary Adult, primary email *
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Primary Adult, secondary email
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Student phone (if different)
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Student email (if different)
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Payment Method *
PLEASE ELECTRONICALLY SIGN WITH YOUR FULL NAME BELOW *
I understand that all payments are non-refundable and that my space in the class is not reserved until FULL payment has been received. - A minimum, non-refundable, 50% deposit is required. - Full payment is due 5 days prior to the first day of class. - Student's space is NOT guaranteed until FULL payment has been received. - A $5 credit card processing fee will be added to ALL credit card payments (online or by phone).
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