Student's Name *

First Name

Last Name

Student's Date of Birth *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone Number *

(###)

###

####

Second Parent/Guardian Name

If applicable

First Name

Last Name

Second Parent/Guardian Phone Number

If applicable

(###)

###

####

Emergency Contact Name *

Please enter the name of a person OTHER than yourself or the second parent/guardian.

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Student's Cell Phone Number

Not required - HIGHLY recommended for students middle/high school level classes

(###)

###

####

Student's Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Who is authorized to pick up your student from class?

If applicable, please list any ADDITIONAL people who may pick up your student. It is not necessary to list yourself, the second parent/guardian, or the emergency contact again.

First Name

Last Name

First Name

Last Name

First Name

Last Name

First Name

Last Name

My student is registering for the following classes: *

Check all that apply.

Sing a Song of Aesop

Once Upon a Dream

Tap & Jazz Homeschool

The Distracted Scholar's Guide to Literature and Drama

Beginning Dance for Musical Theatre - Monday

The Cheese Stands Alone

Thwacked! A Fable

Superheroes, Unite!

Jazz Technique for Musical Theatre - Level 1

Advanced Jazz Technique

Just Tap

Begining Dance for Musical Theatre - Saturday

Mr. Rhythm's Circus

Kitty Cat Capers

The Entire American Revolution (in 40 Minutes or Less)

How did you hear about our theatre classes? (please select all that apply) *

Returning Academy student

Email

Program for an ACT show

During ACT camps/camp shows

Referred by family/friend

ACT website

Online search for children’s theatre opportunities

Event or Curriculum Fair Booth

Flyer or Pamphlet

Peachjar

Macaroni KID

familyeguide.com

Crosstimbers Gazette ad

Facebook

Instagram

Snapchat

Other*