Registration
Intro to Mime Mime is a useful skill that helps performers of all disciplines learn to be more expressive on stage. Explore this unique art form in this fun introductory class. Learn body control exercises, illusionistic mime technique, gesture and expression, and create pantomime skits.
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info (Not Contact #1 or #2)*
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
Assumption of Risk
  (Show-Hide Details)
I've read the above and agree.
 
Hold Harmless
  (Show-Hide Details)
I've read the above and agree.
 
Release of Liability
  (Show-Hide Details)
I've read the above and agree.
 
Illness
  (Show-Hide Details)
I've read the above and agree.
 
Media Release
  (Show-Hide Details)
I've read the above and agree.
 
Right to Refuse Service
  (Show-Hide Details)
I've read the above and agree.
 
Safety Rules
  (Show-Hide Details)
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*
 
 
eCheck/Bank Draft:
Bank Name:
Bank Routing Number: (9-digit number)
Your Account Name: (Your name on your bank statement)
Your Account Type:   Account Number: