EmailMe Form - Be Theatre Student Information

Student Name *

First Last

Date of Birth *

MM / DD / YYYY

Grade (Spring 2024)

Parent Name *

First Last

Email *

Confirm

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Parent Cell Phone *

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

Please list those who can pick up your child:

Emergency Contact Name
Other than parent listed *

Emergency contact phone

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

Please select class *

You may use my child's image on social media. *

Yes, you may use my child's image

No, please do not take photos with my child in them.

If your child has special behavioral needs or food allergies please list here. This information helps us to make the classroom experience better for everyone including your child. Thank you!