Registration
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At least two workshops are required for those trying out for The Company pre-professional level. Those interested in Team are required to attend at least one workshop. Those in Novice are invited but not required. All workshops are strongly recommended to feel confident going into May 30th.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info (Not Contact #1 or #2)
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities ("NONE" if nothing):
*
Allergies ("NONE" if nothing):
*
Primary Doctor:
*
OTC Medications Approved:
*
Approved to Leave on Breaks?:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities ("NONE" if nothing):
*
Allergies ("NONE" if nothing):
*
Primary Doctor:
*
OTC Medications Approved:
*
Approved to Leave on Breaks?:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities ("NONE" if nothing):
*
Allergies ("NONE" if nothing):
*
Primary Doctor:
*
OTC Medications Approved:
*
Approved to Leave on Breaks?:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities ("NONE" if nothing):
*
Allergies ("NONE" if nothing):
*
Primary Doctor:
*
OTC Medications Approved:
*
Approved to Leave on Breaks?:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
*
Grade Level:
*
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities ("NONE" if nothing):
*
Allergies ("NONE" if nothing):
*
Primary Doctor:
*
OTC Medications Approved:
*
Approved to Leave on Breaks?:
*
Questions/Options:
Are you considering The Company tryouts?
(checked=yes)
Are you considering The Team placements?
(checked=yes)
Are you considering The Novice placements?
(checked=yes)
Additional Information:
Other Questions/Comments:
Please fill out ONE of the Payment Methods.
Credit Card Verification:
Add Credit Card
eCheck/Bank Draft:
Bank Name:
Bank Routing Number:
(9-digit number)
Your Account Name:
(Your name on your bank statement)
Your Account Type:
Checking
Savings
Account Number:
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