SUMMER 2019 High School/ College Registration
Welcome to Broken Leg Productions, we are so excited for the summer ahead and that you will be joining us. Once your registration is complete you will receive a welcome e-mail from us to confirm that we have received your registration within 48 hours. Feel free to contact us at email@example.com with any questions you may have.
*Please note credit cards take up to 48 hours to process
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
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.
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)
I am registering for:
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.
-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)
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