Summer 2020 Middle School Registration Form
Welcome to Broken Leg Productions, we are so excited for the Fall ahead and that you will be joining us. Once your registration is complete you will receive a confirmation email with receipt of payment within 48 hours. Feel free to contact us at email@example.com with any questions you may have.
Parent 1 Name
Parent 2 Name
Additional Email (Optional)
Please only e-mail me information pertaining to this program
Please e-mail me regarding all BLP youth programming
Please add me to the BLP general mailing list
Address Line 2
Town, Zipcode, State
Preferred Pronouns (He/Him) (She/Her) (They/Them) Etc.
Grade Entering in Fall '20 (must be entering 4th through 9th grade)
Adult Tee Shirt Size (xs-xxl)
How did you hear about BLP and our Summer Programming?
Anything else we should know? Please use this space to let us know anything that would help to make this the best experience possible for your student (allergies, behavioral/ physical limitations, Epipens, etc)
Relationship to Student
Other people allowed to pick up/drop off child
If anyone other than parents or emergency contact will be picking up/dropping off student, please let us know here.
Relationship to student
Unknown at this time, but will inform BLP if this changes.
No one else will be picking up/ dropping off my student
I give consent for my child to walk/ bike home
I am registering for:
Peter Pan JR
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.
Additionally, we have read BLP's COVID-19 safety protocols and understand we will be asked to sign a liability waiver.
-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)
Discount Code (if available)
I would like to:
Pay my full tuition now
Pay $100 of my tuition now with the rest due the day of auditions/ first session ($100)
I will apply for a scholarship for partial tuition coverage (No charge will be made until we have made a determination)
Name On Card
Expiration Date (mm/yy)
CVV (3 or 4 Digit code found on the back of your card)
Billing Zip Code
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)
Set construction and painting
Front of House