Winter Break Drama Day Camps We would love to have your child join us for a class. Please complete the form below to register your child. Please note, registration forms will be processed in the order they are received. Classes do have size limits. We will contact you directly to confirm your registration. Registration will be complete when we receive your payment. Parent/Guardian informationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Contact Phone*Which Session would you like?*Select OneMONDAY, DECEMBER 21, 2015TUESDAY, DECEMBER 22, 2015MONDAY, DECEMBER 28, 2015TUESDAY, DECEMBER 29, 2015Child InformationChild's Name* First Last Age*3456789101112131415161718Date of Birth* Date Format: MM slash DD slash YYYY Grade in School*Select OneSelect OnePreschoolKindergartenFirstSecondThirdFourthFifthSixthDoes your child have any allergies?*Select OneNoYesIf you answered Yes, please list them below*Is there anything else we should know about your child?How did you hear about us?RadioTelevisionNewspaperBillboardPosterHandoutMy child's SchoolA FriendA ColleagueA little birdieEmergency ContactName* First Last Email Phone*Relationship to child*Alternate Adult Authorized to pick up ChildName First Last PhoneRelease FormI hereby give permission to Wedgwood Drama Studio to photograph and video my child while involved in class activities and performance and I hereby give authorization to Wedgwood Drama Studio to use such photographs for ALL promotional use - website, brochures and/or other publicity purposes.Permission*Select OneI DO NOT grant my permissionI grant my permissionPayment Options*Select OnePay with PayPalPay with a Credit CardCredit Card* DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Class Registration amount* Price: $65.00
