PCA Class Registration
A separate registration form must be completed for each participant and for each individual class.
Class
*
Please Select
World of Art (WED, gr 2-5, Apr/May)
Take the Stage JR (WED, gr PreK-1, Apr/May)
World of Art (WED, gr 5-8, Apr/May)
Take the Stage (WED, gr 2-5, Apr/May)
STUDENT INFORMATION:
(One student per form)
Student Preferred First Name/Nickname (please use the name/nickname they would like to be called & written on name tags)
*
Student Last Name
*
Preferred Pronouns
*
she/her
he/him
they/them
Other
Grade (2022-2023)
*
Please Select
PreK
K
1
2
3
4
5
6
7
8
9
10
11
12
Age on first day of class
*
Please Select
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Date of Birth
*
-
Month
-
Day
Year
Date
Name of School
*
Please share any information that will help us provide the best possible experience for your child (include things like: allergies, behavioral challenges, anxiety, etc., or enter "none")
*
Student Cell Phone Number
Please enter a valid phone number.
Student Email
Confirmation Email
example@example.com
PARENT/GUARDIAN CONTACT INFORMATION:
Adult 1 Name
*
First Name
Last Name
Adult 1 Cell Phone Number
*
Please enter a valid phone number.
E-mail that is checked regularly
*
Confirmation Email
example@example.com
Adult 2 Name (EMERGENCY CONTACT)
*
First Name
Last Name
Adult 2 Cell Phone Number
*
Please enter a valid phone number.
Adult 2 E-mail ONLY IF THEY WANT TO BE INCLUDED ON ALL COMMUNICATIONS
Confirmation Email
example@example.com
Student Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
**PAYMENT INSTRUCTIONS** After you hit the submit button below, YOU MUST RETURN TO THE PCA WEBSITE/PAGE FOR CLASS REGISTRATION AND CLICK THE PAY NOW BUTTON to make payment online. Registrations without a corresponding payment will not be considered enrolled. You DO NOT NEED A PAYPAL ACCOUNT TO PAY WITH PAYPAL. AT PAYPAL LOGIN PAGE SCROLL DOWN TO GREY BOX THAT SAYS PAY WITH CREDIT OR DEBIT CARD and pay with your preferred card.
*
I understand
Indicate your method of Payment
*
PayPal
Check - HAND DELIVER: click on "Pay with Check" for instructions and form to print and put inside the secure mailbox at PCA Classroom 1 at The Fitz BEFORE the first day of class
Check - MAIL: click on "Pay with Check" for instructions and form to print and mail to PCA's P.O. Box
Please list the date by which we should expect to receive payment
*
May we use photos/videos from class/rehearsal/performaces that include your child on the PCA website or social media?
*
Yes, my child may appear in photos/videos on the PCA website or social media that are taken during class/rehearsal/performances.
No, I do not want my child to appear in photos/videos. Please obscure their face in any photos/videos that are used.
Parent/Guardian Signature
*
Clear
Name of parent/guardian signing
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: