Registration/Health Form

1. Please complete our online registration form and click SUBMIT once you are finished.

2. Please send deposit check of $150 made payable to theatre e3 to address below.

3. You will receive a confirmation email once we have processed your registration.

* required field

Student Information

*Student's First Name: *Last Name:

*Age: *Birthday (DD/MM/YYYY): *Year in School:

 

Parent Information

*First Parent's Full Name:

*First Parent's Street Address:
*City: *State: *Zip :

*First Parent's Primary Phone: Secondary Phone:

*First Parent's Email: (Required to confirm receipt of your registration)

 

Second Parent's Full Name:

Second Parent's Street Address:

City: State: Zip :

Second Parent's Primary Phone: Secondary Phone:

Second Parent's Email:

Emergency Contact Information

*Emergency Contact:

*Relationship:

*Phone:

 

Health Information

*Physician Name: *Physician Phone:

Allergies/Health Needs:

 

Additional Information

Additional Comments:

Check here if you are a returning student

Check here if siblings are attending

or



Print a mail-in form
Mail Registration/Health Form and deposit check of $150 made payable to theatre e3 to:
theatre e3 • Attn: Eric Severson • 3409 Emerson Ave S #1 • Minneapolis, MN 55408

 

 

 

© 2006 theatre e3
The contents of these pages cannot be used without permssion from theatre e3
theatre e3 is a non-profit organization

Last modified March 19, 2010