Showstoppers 2017 Fall After School
Registration for Bah Humbug! and Tiny Tim and Friends.
First Name of Actor
Your answer
Last Name of Actor
Your answer
Date of Birth
MM
/
DD
/
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 we need 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 want to volunteer?
Your answer
What is your name?
Your answer
Will you pay tuition by check or online at Square?
I understand that a payment 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 Fall After School 2017
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