Student Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Gender *

Male

Female

Non-binary

Parent/Guardian *

First Name

Last Name

Home Phone *

(###)

###

####

Cell Phone *

(###)

###

####

Work Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you serve on a PTA or PTO? *

Yes

No

Emergency Contact *

First Name

Last Name

Emergency Contact Home Phone *

(###)

###

####

Emergency Contact Cell Phone *

(###)

###

####

Emergency Contact Work Phone

(###)

###

####

*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 he/she is registering. *

Agree

Disagree