2024 Kid's Production Registration Form
Student Information
Name
*
First Name
Last Name
Student Gender
*
Please Select
Male
Female
Prefer Not To Answer
Other
School District
*
School Attended
*
Address
*
Street Address
Street Address Line 2
City
State / Province
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Birthday
*
-
Month
-
Day
Year
Date
Age
*
Parent/Guardian Contact
Name
*
First Name
Last Name
Relationship to Student
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Emergency Contact
Name
*
First Name
Last Name
Relationship To Student
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Please list any previous dance or acting experience:
*
How did you hear about us?
*
I give permission for my child’s photo to be taken and used for publicity on social media or other promotional platforms.
*
Please Select
Yes
No
I understand that all sales are final and there are no refunds for classes even if we decide we cannot attend a class. I also understand that if I am unable to attend a session I have paid for that Creative Pursuits Academy will do their best to offer a different class within that same quarter of equal value
*
I agree
Please choose the shows you would like to participate in:
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( X )
Annie Jr Summer Camp (2 weeks)
Rising Grades 5th - 12th
$
350.00
Quantity
1
2
3
4
5
6
7
8
9
10
Willy Wonka Kids Summer Morning Camp 9 am - 12 pm (1 week)
Rising Grades 1st - 8th
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Willy Wonka Kids Summer Afternoon Camp 1 pm - 4 pm (1 week)
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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