WINTER STARS REGISTRATION FORM - Martha's Vineyard Playhouse

WINTER STARS REGISTRATION FORM

Please fill out the form below to register your child, one form per child please.

STUDENT INFORMATION
CHILD'S NAME*
First Last
BIRTHDATE*
Date Format: MM slash DD slash YYYY
AGE*
GRADE & SCHOOL*
PRONOUNS*
Please select any/all that apply.
- she/her/hers
- he/him/his
- they/them/theirs
Winter Stars (Grades 3-8) runs from Jan. 27 until Apr. 14*
- January 27 - April 14 on MONDAYS 3:30 pm - 4:45 pm (no classes on Feb. 17 or during Feb. school vacation)
PARENT INFORMATION
PARENT NAME*
CONTACT PHONE NUMBER*
CONTACT EMAIL*
Enter Email Confirm Email

Please provide an email so we may send you a confirmation of registration.
PARENT NAME (2)
CONTACT PHONE NUMBER (2)
CONTACT EMAIL (2)
Enter Email Confirm Email
PERMANENT MAILING ADDRESS*
Street Address City State / Province / Region ZIP / Postal Code Country
EMERGENCY INFORMATION
EMERGENCY CONTACT PERSON*
EMERGENCY CONTACT PHONE NUMBER*
IMPORTANT MEDICAL INFORMATION / ALLERGIES*
IMPORTANT: Please provide a copy of your child's current medical and immunization records by the first day of class.
I give permission for my child to be photographed / videotaped by representatives of Martha's Vineyard Playhouse during their participation in Winter Stars After-School Program. *Note: We never use student's names in our marketing materials.*
- Yes
- No

STUDENT INFORMATION