EmailMe Form - Spring 2020 REGISTRATION- Xanadu

Student Name

First Last

Student Preffered Pronouns (He/Him) (She/Her) (They/ Them), etc.

Parent 1 Name

First Last

Parent 2 Name

First Last

Student Email

Parent Email

Additional Email (Optional)

Mailing lists

Address

Address Line 2

Town, Zipcode, State

Parent Phone

### - ### - ####

Student Phone

### - ### - ####

Student Grade (Must be entering grades 8-12 at the begining of the 19-20 school year)

How did you hear about us?

REGISTRATION

I am registering for: *

Xanadu

Audition night will be quite important for each session. Please make sure to note when it is (February 11th with callbacks on Frebruary 12th) *

Yes, we know when our audition date is and we are able to attend.

We know when our audition date is and have a conflict but will coordinate an alternative audition date or a video submission with brokenlegdrama@gmail.com

My student and I have read the cast contract document on the registration page and agree to adhere to the rules and regulations set forth. *

Yes

Anything else we should know?

PAYMENT

-This is a secured form
-Please allow 48 hours for payment to process
-When processed you will receive a confirmation from Square (the company we use to process credit cards)

I would like to: *

Pay my full tuition now ($350)

Pay $100 of my tuition now with the rest due the day of auditions($100 Now, Balance of $250)

We will be submitting a need-based scholarship application (No charge will be made until scholarship has been determined)

Payment Method

Name On Card

Card Number

Expiration Date (mm/yy)

CVV (3 or 4 Digit code found on the back of your card)

Billing Zip Code

PARENT SUPPORT

Parent support is wonderful but not required, please let us know if your are interested in helping behind the scenes!

I would be interested in helping with the following areas (check as many as apply)