2017 Summer Registration
This registration is for Showstoppers' 2017 Summer Teen Ensemble Les Mis
Actor's First Name
Actor's Last Name
Actor's Date of Birth
School Actor Attends
Please include house or apartment number, and street name
Actor lives with
Name of person registering this actor (First parent or guardian)
Please give us your name
What is your phone number?
Phone number we would call to speak to you.
What is your email address?
Please give us the best email to communicate about this session of Showstoppers
Second parent or guardian's first and last name
Phone number of 2nd parent or guardian
Email address of 2nd parent
Enter only if this person would like current information about this session.
used only if the people listed above cannot be reached
relationship to actor
This person's phone number
Medical Insurance Company
Insurance Policy Number
Actor's doctor or medical group
Phone number of doctor or medical group
If your child has a medical emergency or accident, what should be done?
You, and others listed will be called first. Give as much guidance as you can.
Please list any medical conditions, or special needs we should be aware of.
Is special equipment or skill needed to deal with this?
What is your name?
Do you or another member of your family wish to volunteer for jobs during rehearsals or performances?
I wish to make a donation
How do you intend to pay tuition?
Mailing address and link to mail online will be emailed to you.
Mail a check
Do you confirm that all information provided by you is correct and complete?
Do you understand that enrollment is not complete until payment has been made?
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.
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