Student Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Parent/Guardian 1 *

First Name

Last Name

Cell Phone Number *

(###)

###

####

Secondary Phone Number

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you serve on a PTA or PTO? *

Yes

No

Parent/Guardian 2 *

First Name

Last Name

Cell Phone Number *

(###)

###

####

Secondary Phone Number

(###)

###

####

*Please read carefully - I give permission for still or video pictures of my child to be used by Gamut Theatre Group for promotional purposes. *

Agree

Disagree

*Please read carefully - I hereby give my permission for my child (named above) to attend the session for which they are registering. *

Agree

Disagree