Showstoppers 2019 After School
Registration for our musical version of Midsummer Night's Dream
Our 2019 Fall Session for Ages 7 to 13
Written by Harriet Bender for Middle School and Elementary Students.
Email address *
First Name of Actor *
Your answer
Last Name of Actor *
Your answer
Date of Birth *
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DD
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YYYY
School Actor Attends *
Your answer
Gender *
Age *
Your answer
Actor's Home Address *
Your answer
Zip Code *
Your answer
Who does actor live with? *
Name of person registering Actor *
Your answer
Your email address *
Your answer
Your phone number *
Your answer
Second Parent or Guardian *
Your answer
Best phone number for this parent *
Your answer
Second parent Email address (if different from yours) *
Your answer
Please list an emergency contact, in case parents and/or guardians cannot be reached. Parents are always contacted first. *
Your answer
Emergency contact's relationship to your child. *
Your answer
Emergency contact's best phone number. *
Your answer
Health Insurance carrier *
Your answer
Policy # *
Your answer
Doctor and Medical Group *
Your answer
Doctor and Medical Group's phone number *
Your answer
Does your child have any medical conditions, allergies, or special needs that the directors should to be aware of? *
Your answer
If so, please list
Your answer
What information or special equipment do we need while your child is in our care? *
Your answer
Would you or a family member be willing to volunteer? *
What is your name? *
Your answer
Will you pay tuition by check or online at Square? *
I understand that a payment for tuition of $525 must be made before enrollment is complete. *
I confirm that all information is correct and complete. *
Required
Electronic Signature By checking "I agree" I affirm consent, and agree that: My electronic signature on this form above the same effect as if I signed this form in ink. *
Required
Your legal name *
Your answer
I am enrolling my child for 2019 Fall After School Session starts June 10 at La Colina Jr High. Tuesdays and Thursdays 4 to 6 PM. Two performances will be November 8 and 9, 2019 Email sbshowstoppers@gmail.com or call (805) 314-1221 for payment information and early registration discounts. *
A copy of your responses will be emailed to the address you provided.
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