REGISTRATION ON-LINE MADE EASY

REGISTRATION

The registration fee of $175.00, which includes registration, 12 week workshop training in song, dance, and acting, show T-shirt, show memory program, trophy and production is nonrefundable.  Checks should be made out to Broadway Starz®.  Students are responsible for (costume, footwear, make-up, tights, etc., and any applicable parking fees).

TODAY'S DATE:   E-Mail Address:

NAME OF PLAY YOU ARE REGISTERING FOR:

Students First Name:    Last Name:

Age:    Birth date: Month:   Day:   Year:    Sex: Male:  Female:

Name of School:    Grade:

Address:   City:   State:   Zip Code:

Parent(s), Guardian(s) Name:

Home Phone Number:   Cell Phone Number:

How did you hear about our program?

Have you participated in any other Broadway Starz® shows?  Yes: No:

Which ones?   Have you ever participated in theatre before?  Yes: No:

EMERGENCY CONTACT INFORMATION

Emergency Contact(s):

Name:   Contact Number:

Name:   Contact Number:

Are there any special medical considerations that we need to know about? (i.e.: allergies, diabetes, etc.):

PROGRAM ADDITIONS

T-Shirt Size: Child Small: Child Medium: Child Large: or

T-Shirt Size: Adult Small: Adult Medium: Adult Large: Adult X-Large: Adult XX-Large:

Trophy: How do you want student's name to appear on trophy?

PAYMENT INFORMATION

How will you be paying for your registration of $175.00?

CASH:   CHECK:   CREDIT CARD :   PAYPAL:

We accept credit cards, bank transfers, debit cards, e-checks and more through Paypal

(If paying by Check, Credit Card or PayPal, please submit form first then come back to pay

There is an additional $10 fee to pay online with Check, Credit Card or Paypal

Cash or check can be mailed or brought to registration)

Please submit form.

When you arrive at the rehearsal hall we will have this registration form available for you to sign and date.

Thank You!