Blue Pearl Theatrics

Blue Pearl Theatrics

Mid-Winter Recess Performing Arts Program Registration Form
Student's Name*

First NameLast Name
Age *
School Grade
Parent Email Address:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent Name*

First NameLast Name
Parent Phone Number*

Area CodePhone Number
Parent Name

First NameLast Name
Parent Phone Number

Area CodePhone Number
Person to be contacted in case of emergency (other than parent)
Contact Name*
Contact Phone Number*

Area CodePhone Number
Contact Name*
Contact Phone Number*

Area CodePhone Number
If no contact is made, I give permission for my child to be transported to the nearest medical facility
YesNo
Signature (Type name as signature) *
Does your child have any medical conditions, past injuries, or allergies that we should be aware of?
YesNo
If yes, please explain
Siblings who will also be attending Blue Pearl Theatrics Holiday Performing Arts Program:
Name of person/s who can pick up your child:
How did you hear about Blue Pearl Theatrics Children's Theater Program?
BackstagePlaybillFacebookInstagramGoogleMommy PoppinsKid PassHi SawyerOther
Please describe your child's acting/dancing/performance experience:
PAYMENT METHOD:

(Check, money order, or C.C. must be in U.S. funds made payable to Blue Pearl Theatrics.)

Please check appropriate option below:
C.C./Debit CardCashMoney Order
Enclosed is my payment:
Mid-Winter Recess Performing Arts Program, Full Payment - $695Mid-Winter Recess Performing Arts Program (Payment Plan) Deposit - $250
Payment Information

Mid-Winter Recess Performing Arts Program (5 days, 9:00 am- 4:00 pm)$695.00

February 17 - February 25, 2024

Mid-Winter Recess Performing Arts Program - Payment Plan Deposit$250.00

Payment Plan - 3 installments of 250

Total $0.00

Credit Card

Signature (Type name as signature) *
Should be Empty: