4 Week Mid-Term Registration 4 Week Mid-Spring Registration Registration Date * 1st STUDENT'S INFORMATION Student1 Name * Date of Birth * Age * Sex * Male Female Do you attend a Yonkers Public School? * Yes No If "Yes" then please enter the name of the school. Grade Select Desired Courses Hip Hop Dance w/Ruben Antoine - Tues @3:30pm - $25 Vocal Percussion w/ Mr. Nick - Tues @4:20pm - $25 Acting w/Mr. Clark - Thurs @3:30pm - $25 Art w/Ms. Benitez - Thurs @4:30pm - $25 Class Registration 2nd STUDENT's INFORMATION Student2 Name Date of Birth Age Sex Male Female Do you attend a Yonkers Public School? Yes No If "Yes" then please enter the name of the school. Grade Select Desired Courses Hip Hop Dance w/Ruben Antoine - Tues @3:30pm - $25 Vocal Percussion w/ Mr. Nick - Tues @4:20pm - $25 Acting w/Mr. Clark - Thurs @3:30pm - $25 Art w/Ms. Benitez - Thurs @4:30pm - $25 Class Registration 3rd STUDENT'S INFORMATION Student3 Name Date of Birth Age Sex Male Female Do you attend a Yonkers Public School? Yes No If "Yes" then please enter the name of the school. Grade Select Desired Courses Hip Hop Dance w/Ruben Antoine - Tues @3:30pm - $25 Vocal Percussion w/ Mr. Nick - Tues @4:20pm - $25 Acting w/Mr. Clark - Thurs @3:30pm -$25 Art w/Ms. Benitez - Thurs @4:30pm - $25 Class Registration 4th STUDENT'S INFORMATION Student4 Name Date of Birth Age Sex Male Female Do you attend a Yonkers Public School? Yes No If "Yes" then please enter the name of the school. Grade Select Desired Courses Hip Hop Dance w/Ruben Antoine - Tues @3:30pm - $25 Vocal Percussion w/ Mr. Nick - Tues @4:20pm - $25 Acting w/Mr. Clark - Thurs @3:30pm - $25 Art w/Ms. Benitez - Thurs @4:30pm - $25 Class Registration 5th STUDENT'S INFORMATION Student5 Name Date of Birth Age Sex Male Female Do you attend a Yonkers Public School? Yes No If "Yes" then please enter the name of the school. Grade Select Desired Courses Hip Hop Dance w/Ruben Antoine - Tues @3:30pm - $25 Vocal Percussion w/ Mr. Nick - Tues @4:20pm - $25 Acting w/Mr. Clark - Thurs @3:30pm - $25 Art w/Ms. Benitez - Thurs @4:30pm - $25 Class Registration PARENT / GUARDIAN INFORMATION Parent / Guardian Name * Relationship to Student * Street Address * City * State * Zip Code * Phone Number * Email Address * Set & Confirm New Member Password * Confirm Set & Confirm New Member Password * Total Tuition (No Registration Fees) RETURNING STUDENTS Approximate Date of Last Registration RELEASE OF RESPONSIBILITY In giving my consent, I further release YOUTH THEATRE INTERACTIONS, INC. (YTI) and its administrators, instructors, or any person acting on behalf of YTI of any responsibility for accident or injury as a result of participating in this virtual instructional program. Parent / Guardian Signature * Clear Date * If you are human, leave this field blank. Δ
