2011 SUMMER STOCK KIDS REGISTRATION FORM

SUMMER STOCK KIDS (ages 8 - 12)

Mondays-Fridays, 9:00 a.m. - 3:00 p.m.
June 13 - 24, 2011
Performances are Saturday, June 25th at 11:00 a.m. and 2:00 p.m.
Instructor: Jene Rebbin Shaw
Fee: $400.00

Classes and performances are held at the Caryl D. Phillips Creativity Center at 116 N. Jefferson Street in downtown Dayton.

To register online, complete the form below. After submitting this form you will be directed to
PayPal where you can make payment with your credit card or PayPal account.
(A PayPal account is not required to pay with a credit card via PayPal)
PayPal

Note: One registration for per student. Payment must be made at time of submitting this registration form.

Please supply the following contact information:

 
Student Name:
Parent/Guardian Name:
Street Address:
City/State/Zip:
Cell Phone:
Other Phone:
E-mail:
   
 
 
 
Amount of Payment: