Palace Theatre Performing Arts School Registration

Student Name*

First NameLast Name

Parent Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

example@example.com

Date of Birth*

MonthDayYear

Grade entering Sept 2026*

Class Choice*

Tshirt Size

Enter the message as it's shown*

My Products*

Summer Time To Shine$200.00

Grades K- 4th

Little Mermaid Jr$500.00

4-10 grade Includes 5 meat raffle tickets to recoup $50 of tuition

This year our Summer PPAS camp tuition will include 5 tickets to our meat raffle that families can sell ($10 admission ticket) to recoup $50 of their costs.

If you have any questions please call (716) 438-1130 or email Rachel@lockportpalacetheatre.org

Please make checks payable to Historic Palace Theatre

You will be automatically directed to PayPal to complete this transaction, if you would like to pay with cash or check, please print it out and you can either drop it off at our box office during our business hours (Mon-Fri 10-2) or mail it at:

PO BOX 19 Lockport, NY, 14095

Registration is not complete until payment has been taken.