Registration
2 openings left in this event!
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Please know that this is only the registration form. You must still log into your jackrabbit account and click on the blue "Make a Payment" button in order to complete this transaction. $100 deposit is required. The event is open to approximately 45 students and 12 adults.
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
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 Name, Number, Relationship
(Not Contact #1 or #2)
*
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non binary
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non binary
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non binary
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non binary
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non binary
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Questions/Options:
Have you signed the Trip Waiver form
Yes
No
Lunch choices: Pasta Primavera; Spaghetti & Meatballs; Cheese Pizza; Salad w/grilled Chicken; Chicken Hero; Chicken Parmigiana
*
Additional Information:
Participant Responsibilities
(Show-Hide Details)
PARTICIPANT RESPONSIBILITIES: The registered participant agree to the following:
Acceptable Conduct by Participant. During attendance and participation, the participant will act in a responsible manner and will abide by the instructions of any Starlight’s Youth Theatre chaperone’s, and will comply and follow the rules.
I've read the above and agree.
Enter your Full Name:
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