2021 ~Virtual~ Winter Workshops

2021 Winter Workshops Student Registration Form

Fill out the form carefully for registration. This year's workshops will be held entirely on ZOOM. Please make sure you have access to a reliable internet connection and a ZOOM account.
Student's Name *

First Name Last Name
Birth Date *

Month Day Year
Parent/Guardian Name

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact E-mail *
example@example.com
Please confirm you have a reliable internet connection and a ZOOM account. *
Mobile Number *

Area Code Phone Number
I, First Name* Last Name* give Bloomsburg Theatre Ensemble to use any images of myself or likeness taken during workshops for promotional needs in the future at BTE. By signing, I grant this permission. Signature*

Emergency Contact Information

Please fill this in with information not already provided.
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Any health issues that we need to know about in order to better accommodate you in a ZOOM workshop setting? (If yes, please specify.) *
How did you hear about us? (Check all that apply.) *

Returning Student BTE's Website Facebook or OTHER Ad Email Follow us on Facebook/Instragram Friend/Referral

2021 Winter Workshops Student Registration Form