Student Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Parent/Guardian 1 *

First Name

Last Name

Cell Phone Number *

(###)

###

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Secondary Phone Number

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian 2 *

First Name

Last Name

Cell Phone Number *

(###)

###

####

Secondary Phone Number

(###)

###

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Select Below Which Weeks of GTSA you wish to register your child for:

Select ALL that apply

Week 1: Shakespeare

Week 2: Shakespeare

Week 3: Traveling Tales

Week 4: Page to Stage

Week 5: Shakespeare in the Woods

*Please read carefully - I give permission for still or video pictures of my child to be used by Gamut Theatre Group for promotional purposes. *

Agree

Disagree

*Please read carefully - I hereby give my permission for my child (named above) to attend the session for which they are registering. *

Agree

Disagree