WAIT LIST Summer 2025 Youth Program Enrollment Form

Student Name*

First NameLast Name

Student Pronouns

Date of Birth*

MonthDayYear

Grade in School as of September 2024*

Name of School *

Parent Email for program communication*

example@example.com

Student Email for program communication (if none, please specify) *

Parent Phone Number*

Area CodePhone Number

Student Race

Student Ethnicity

Hispanic/LatinoNot Hispanic/Latino

Are there any learning, behavioral, or medical challenges we should be aware of in order to maximize your student's success? Please specify as needed.

Adult T-shirt Size

Parent/Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent Phone Number*

Area CodePhone Number

Parent/Guardian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

E-mail

example@example.com

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship to Student*

My student and I have reviewed and agree to abide by BLP's...*

Cast contract

My student and I have reviewed and agree to abide by BLP's...*

Bullying/Harassment policy

My student and I have reviewed and agree to abide by BLP's...*

Photo/Video policy

AT THIS POINT IN TIME, THIS PROGRAM HAS REACHED CAPACITY. YOU ARE SIGNING UP FOR OUR WAIT LIST. No payment is due at this time. Should you be moved from the wait list to the participant list, you will be required to submit payment. We will provide payment options at that time, should it be necessary to do so.

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Our mini session (Finding Nemo KIDS) will run from June 23rd-27th, with 1 performance on June 27th.

Full program calendars, including dates and times for tech rehearsals, will be shared ahead of the start of programming and are available on our website.

This year's Summer Youth Program tuition will be $300 for the mini session.

If you would like to apply for a scholarship, please reach out to info@brokenlegproductions.com. BLP strongly believes that educational theater programming should be available to all students, regardless of their ability to pay.

Refund Policy

If you decide you would no longer like to participate in BLP's summer programming after registering, you will forfeit your deposit. Your remaining tuition (minus deposit) will be refundable until the audition date in the event that you need to withdraw from programming. No refunds will be issued after the audition process has been completed.

Please choose your programming*

Youth Mini Session (Finding Nemo KIDS) $300

I acknowledge that I am signing up for the wait list and may not be guaranteed a space in this program.*

Wait list acknowledgement

I understand that if I am moved off the wait list to the participant list, I will be responsible for all applicable payments.*

Payment acknowledgement

At BLP we strive to help families in need access our theatrical programming. If you are able, please head to our donation page to support our scholarship program and help to sponsor a student who might otherwise not be able to participate.

Youth Program Summer Enrollment: WAIT LIST

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

PARENT/GUARDIAN 2 INFORMATION

Emergency Contact

Attestations

Program Information