REGISTRATION FORM

Name:______________________________

Address:_______________________________

Town/Zip:______________________________

Phone:______________ Cell:______________

Email:_________________________________

Age:________________Grade:_____________

Parent(s):______________________________

Emergency Contact_____________________

Emergency Phone ______________________

I am registering for the following:

___  Voice for the Actor (ages 8-12) $150

___  Voice for the Actor (ages 13-17) $150

___  Intro to Stage Combat II(ages 8-12) $150

___  Intro to Stage Combat II(ages13-17) $150

___  Acting II (ages 8-12) $115

___  Acting II (ages 13-17) $115

___  Movement II(ages 13-17) $150

___  Creating a Character (ages 13-17) $115

___  Intro to Musical Theater (ages 8-17) $115

___  Intro to Dance (ages 8-17) $150

___  Intro to Music Theory (ages 8-17) $100

Total amount $_____________

Please make checks payable to:

    Brundage Park Playhouse

Payment is due at time of registration. No registration will be processed without payment.

Send to: Brundage Park Playhouse

               c/o Municipal Bldg.

               502 Millbrook Avenue

               Randolph, NJ 07869

                 Attn: Vivian Lenyk                                               

I give my child permission to participate in theatre classes and understand that the Township does not insure participants with accident insurance.  I also understand that all fees are non-refundable unless the offered class is cancelled.

X_____________________________________

Parent/Guardian Signature