Online Registration Form

Name of Child(ren) *
Child's current age *
Grade in Fall of 2011 *
Child's Current School
Child's primary home address *
City *
Zip code *
Child's primary home phone *
Name of Parent/Guardian #1 *
Parent/Guardian #1 Cell Phone
Parent/Guardian #1 Work Phone
Parent/Guardian #1 Email Address *
Name of Parent/Guardian #2 (if any)
Parent/Guardian #2 Cell Phone
Parent/Guardian #2 Work Phone
Parent/Guardian #2 Email Address
Does your child have any allergies, other than seasonal? *	Yes No
If yes, please list your child's allergies.
Please list any additional information you would like to provide
Today's date *
Register for Teen Theater	Yes No
Register for Little/Middle Theater	Yes No
	Yes No