Summer Youth Musical Theatre Workshop 2017 Registration Form
PLEASE READ THIS APPLICATION CAREFULLY
Please complete the entire form. After your Online Registration has been received you can mail your Payment to Musicals at Richter, 100 Aunt Hack Road, Danbury, CT 06811
Student's First Name
Your answer
Student's Last Name
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Age as of June 2017
Your answer
What grade will you be going into in the 2017-2018 School Year?
Your answer
I would like my child to be placed in the same group as (must be similar in grade level or age)
Your answer
Mailing Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Name of Parent(s)/Guardian(s)
Your answer
Mailing Address (if Different from Above)
Your answer
Daytime Phone
Your answer
Evening Phone
Your answer
Cell Phone
Your answer
Email Address
Your answer
Emergency Information: Doctor's Name, Phone Number
Your answer
Are you a returning Participant?
Session you are enrolling in:
Will you be needing extended hours? (Early/Late Care)
What is the participant's T-Shirt Size?
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