Blue Pearl Theatrics

Blue Pearl Theatrics

Weekend Fall 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 Weekend Fall 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 CardCheckMoney OrderCash
Enclosed is my payment:
Weekend Fall Performing Arts Program - $1280Weekend Fall Performing Arts Program (Payment Plan) Deposit - $320
Payment Information

Weekend Fall Performing Arts Program$1,280.00

September 28, 2024 - December 21, 2024

Weekend Fall Performing Arts Program - Payment Plan Deposit$320.00

Payment Plan - 4 installments of 320. September 28, 2024 - December 21, 2024

Total $0.00

Credit Card

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