DRAMA-CIZE REGISTRATION WINTER 2021

Session Registration *

Parent/Guardian Name *

First

Last

Child's Name *

First

Last

Birthday: Month / Day/ Year

GENDER

PRONOUNS

Parent Email *

Child Email (if applicable)

Cell Phone

Home Phone

Emergency Contact Phone Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Briefly tell us about your child.

What would you like your child to gain from this class?

Registration Payment *

Price: $ 160.00

Payment for 1 child for 4 sessions

Discount for Multiple Children

Total

$ 0.00