EmailMe Form - Acting Through Tempo

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 *

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Type *

Cell

Home

Work

Other

Address

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

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:

Do you use a mobility device? (This is for the teaching artist to prepare for necessary accommodations.) *

information is for teachers to prep for class

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

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