EmailMe Form - Phamaly Table Read

Name *

First Last

Pronouns (ie: she, them, he, etc.)

We, at Phamaly, strive to uplift the disability identity without shame. If you would like, please share your disability with us (optional)

Email *

*Email is Phamaly's primary method of communication. Please call Darion, 702-493-0475, if another form of communication is necessary.

Primary Phone *

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

Type *

Cell

Home

Work

Other

Address

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

In which county do you reside?

Birthday (MM/DD/YYYY) *

Parent/Guardian (if applicable)

First Last

Relationship

Parent/Guardian Phone

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

Type

Cell

Home

Work

Other

Parent/Guardian Email

If this is your first time participating with Phamaly, how did you hear about us?

Accommodations

Necessary Accommodations for you:

If there is anything else you would like the teaching artist, or any other accommodation we can make for you, please list here:

By clicking this circle you are agreeing to attend this class and acknowleging that an absent seat could have gone to another interested Phamaly actor.

I agree

Phamaly Guidelines for classes at DCPA - Education

• Attend all class sessions. Failure to attend all classes you register for will result in suspension from participating in future Phamaly classes.

• Complete all assignments to the best of your ability.

• No cell phones allowed during class time unless it is a necessary accommodation

• No pictures within class time.

• Participate in all acting exercises and scene work.

• No food allowed during class. There will be a 10 minute break for any snack needs.

• Address any issues that arise privately with the instructor, and leave any outside concerns at the door. Be focused and attentive towards the class!

I agree to all the guidelines above:

First Last

Date Time

MM / DD / YYYY