Acting Out New York Registration Form
Please fill out the information below to complete your student registration. At this time, this form isn't supported by mobile devices, so please fill it out from a laptop or desktop computer.

Within 24 hours of registration, you will receive a PayPal invoice for the tuition at the email you provided. This confirms your registration. If you have any questions please email, text or call. (actingoutnewyork@gmail.com or 310-717-5405)
Name of Student *
Your answer
Child's Age *
Your answer
Parent/Guardian(s) name(s) *
Your answer
What is your Venmo handle? *
Within 48 hours, you will receive an invoice via Venmo. Payment of this invoice secures your spot in the program you are signing up for. If you do not have a Venmo account, please indicate below. You will then receive a PayPal invoice within the same time frame to the email you provide below.
Your answer
Pronouns your child prefers *
Please list all adults who have permission to pick your child up. *
Parents, grandparents, step parents, nannies, etc.
Your answer
Does your child have any medical concerns? *
The honest answering of this question will in no way inhibit your child's enrollment. It is just so we can adjust the curriculum to ensure all the children involved maximize their potential!
Your answer
Does your child have behavioral or emotional concerns? *
Answering this question honestly will in no way inhibit your child's enrollment. It is just so we can adjust the curriculum to ensure all the children involved maximize their potential!
Your answer
Does your child have any allergies? *
Your answer
Parent/Guardian's Email *
Cornell.edu email addresses filter my emails into an unknown location. So, if you have a non-Cornell email address, please use that! This is the email I'll use to send information to you before and during your camp week!
Your answer
Parent/Guardian's Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Are you signing up with a friend? What is their name?
Your answer
Which program are you signing up for? (you can choose more than one) *
Required
Anything else we should know?
Your answer
Would you like to make a small donation to the scholarship program at Acting Out NY?
Suggested donation is $25, but any amount will help! The donation will be added to your PayPal invoice.
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