EmailMe Form - SELF IDENTITY THEATRE CAMP

Today's Date

MM / DD / YYYY

Child's Name

First Last

Parent/Guardian's Name

First Last

Email

Phone

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

Address

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

Child's Age

10

11

12

13

Child's gender

Male

Female

Non-binary

Name of School

What grade will your child be in the upcoming year?

Transportation

Yes

No

Has your child participated in any previous Hattiloo programs/productions?

Yes

No

What's your child's interest? Select all that apply.