RegistrationThoroughly Modern Millie Camp

2019 SUMMER CAMP - Thoroughly Modern Millie (9-18 yrs old)

* Indicates required field

Student's Name *

First

Last

Student Age *

Student's Phone Number *

Student's Email Address *

Parent's Name *

First

Last

Parent's Email *

Parent's Phone Number *

Emergency Contact and Phone Number *

Please list any allergies, medical conditions or medications we should be aware of for the safety of your child during class. *

I have carefully looked at the dates and times listed on the webpage for this show, and the student listed above is available to participate in all class rehearsals and public performances. *

Yes, I am available to participate in all the dates mentioned above. I have schedule conflicts (please list below).

If you have any schedule conflicts, please list them below. *

If you are a student 12-18 years old who would like to help behind the scenes with this show, please list your areas of interest below. *

I understand that class fees (or initial payment, if paying in installments) are due by the first day of class. *

Yes, I understand that payment must be received by the first day of class and will bring a check to Centre Square. Yes, I understand that payment must be received by the first day of class and will be paying online.

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Email

Physical address

director@kentuckyclassicarts.com

237 N. Spalding Avenue, Lebanon, KY 40033
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