Blue Pearl Theatrics

Blue Pearl Theatrics

Holiday Theater Camp Registration Form
Student's Name *

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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent Name *

First Name Last Name
Parent Phone Number *

Area Code Phone Number
Parent Name

First Name Last Name
Parent Phone Number

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

Area Code Phone Number
Contact Name *
Contact Phone Number *

Area Code Phone Number
If no contact is made, I give permission for my child to be transported to the nearest medical facility
*

Yes No
Signature (Type name as signature) *
Does your child have any medical conditions, past injuries, or allergies that we should be aware of?
*

Yes No
If yes, please explain
Siblings who will also be attending Blue Pearl Theatrics Children's Theater Program:
Name of person/s who can pick up your child:
How did you hear about Blue Pearl Theatrics Children's Theater Program?
*

Backstage Playbill Facebook Instagram Google Friend/Family/Word of Mouth Other
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 Card Check Money Order Cash
Enclosed is my payment:
Holiday Theater Camp - $850 Holiday Theater Camp (Payment Plan) Deposit - $300
Payment Information

Holiday Theater Camp $ 850.00

Holiday Theater Camp - Payment Plan Deposit $ 300.00

Total $ 0.00

Credit Card

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