TFKT Registration Summer Camp 2012 .pdf

Theater for Kids/Teens Registration Form

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757-635-6096/425-1445
Theaterforkidsteens1@gmail.com ~ www.theaterforkidsteens.com
(Each child needs its own Registration form. Please, Print Clearly)
Name
Age

Date
Birthday

Grade

Address

School:
City

Zip
2nd Phone #

Reachable Phone #

Do you check your
email regularly?

E-Mail Address
Parent(s) or Guardian(s) name(s)
Emergency Contact if you are unavailable
Child’s/Teen’s training,
talent(s) or skill(s)
Child’s/Teen’s area(s)
of difficulty
How did you hear about us

Sessions/Workshops 2012
Class

Day

Time

Class

Day

Time

Summer Camps 2012
Younger
Children

June 18-29 9am-3pm
July 9-20 9am-3pm
August 20-31 9am-3pm

June 18-29 9am-12pm
July 9-20 9am-12pm
August 20-31 9am-12pm

Tuition Fees are to be paid in advance to the first class unless you have made installment
arrangements in which a $50 Deposit is required.
Checks payable to: Theater for Kids/Teens, 219-A 70th Street, Virginia Beach, VA 23451
Theater for Kids/Teens is a Community driven non-profit
organization. Is there an area of skill, talent or resource that
your family might be able to assist us with? Examples:
Plumber, Electrician, Sewing, Building, Media, Painting,
Xerox Copies, Other:

Full tuition

or $50.deposit

In the case of injury, I will not hold
Grace Atkinson, Theater for
Kids/Teens or Pembroke Mall liable.

Name

I approve the use of media images
taken of my child, for the use of
TFKT marketing purposes.

Name

installments
Date

Date