Showstoppers 2020 After School

Registration for Gilbert and Sullivan's Pirates of Penzance
Our 2020 After School Session for Ages 7 to 13

Email address *

First Name of Actor *

Your answer

Last Name of Actor *

Your answer

Date of Birth *

YYYY

School Actor Attends *

Your answer

Gender *

Male

Female

Age *

Your answer

Actor's Home Address *

Your answer

Zip Code *

Your answer

Who does actor live with? *

Both Parents

One Parent

Guardian(s)

Other:

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? *

Yes

What is your name? *

Your answer

Will you pay tuition by check or online at Square? *

I will mail a check to Showstoppers 3579 Modoc Road Santa Barbara CA 93105

I will pay online at Square.com https://squareup.com/store/sbshowstoppers

I understand that payment for the tuition of $550 must be made before enrollment is complete. *

yes

No, I will call you for more details

I confirm that all information is correct and complete. *

Yes

Option 2

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. *

I agree

Required

Your legal name *

Your answer

I am enrolling my child for 2020 Spring After School Session starts January 26 at La Colina Jr High. Tuesdays and Thursdays 4 to 6 PM. Two performances will be April 9 and 10, 2020 Email sbshowstoppers@gmail.com or call (805) 314-1221 for payment information and early registration discounts. *

Pay online at Square

Mail check to Showstoppers 3579 Modoc Road, Santa Barbara CA 93105

A copy of your responses will be emailed to the address you provided.

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