EmailMe Form - SUMMER 2019 High School/ College Registration

Student Name

First Last

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 Age (Must be 14-21 years of age at the start of the program)

By checking this box, both student and parent understand that both 'RENT: Student Edition' and 'Amelie' contain adult language and subject matter and give consent for their child to participate.

We understand

Grade Entering in Fall '19 (must be entering 9th grade or above)

Anything else we should know? Please use this space to let us know anything thta would help to make this the best experience possible for your student (allergies, behavioral/ physical limitations, etc)

REGISTRATION

I am registering for: *

Rent

Amelie

Both Sessions

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

PAYMENT

-This is a secured form
-All registrations received before 4/1 will receive an automatic $25 discount
-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

Pay $100 of my tuition now with the rest due the day of auditions

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)