Prairie Music & Arts Drama Registration Form
The Drama Program runs for 12 weeks this Winter sessions. The Drama program is for students in Grades 3-6. 2nd graders may be allowed pending approval from the Drama Department Chair.
Last Name of Student *
Your answer
First Name of Student *
Your answer
Home Phone *
Your answer
Parent #1 First and Last Name *
Your answer
Parent #1 Phone (Cell Phone) *
Your answer
Parent #2 First and Last Name
Your answer
Parent # 2 Phone (Cell Phone)
Your answer
Email Address - please list all emails checked most frequently as PMA communicates a majority of information via email. *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Age/Grade in Fall *
School Attending Fall
Your answer
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