dA Children'sTheatre Registration Ages 8-14 Saturday July 7 - September 29, 2018
dA Teatro Para Niños Registracion Edades 8-14 Sábado Julio 7-Septiembre 29 2018

Payment will be collected on the 1st day of class

Email address *
Student's First and Last Name / Nombre y Apeido de estudiante *
Your answer
Address/ dirección *
Your answer
City/ ciudad *
Your answer
State/ estado *
Your answer
Zip Code/ código postal *
Your answer
Telephone/ teléfono *
Your answer
Cell/ celular
Your answer
Emergency contact Name/ nombre de contacto de emergencia *
Your answer
Emergency Contact Telephone/ teléfono de contacto de emergencia *
Your answer
Emergency Contact (Relationship)/ Relación de contacto de emergencia *
Your answer
Special Needs or Health Alerts/ necesidades especiales o alerta médicas
Your answer
Parent's Name who will pay for class/ Nombre de padre que pagara para la clase *
Additional information for students under 18
Your answer
Age/ Edad *
Additional information for students under 18
Your answer
Grade/ Grado
Additional information for students under 18
Your answer
A copy of your responses will be emailed to the address you provided.
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