Spring 2021 Registration Form Spring 2021 Online Registration Form Registration Date * 1st STUDENT'S INFORMATION Student's Full 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 2nd STUDENT's INFORMATION Student's Full 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 3rd STUDENT'S INFORMATION Student's Full 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 4th STUDENT'S INFORMATION Student's Full 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 5th STUDENT'S INFORMATION Student's Full 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 Class Registration In-Person Instruction - socially distanced - $100 per student per class African Dance - Miss Jessica Afro-Beat - Mr Deshawn Acting - Miss Traci Improv - Miss Traci Ballet - Miss Chelsea Tap - Miss Chelsea Screen Writing - Mr Sam Class Registration In-Person Instruction Registration Fee per student per class (example: 1 student 2 classes = $200; 2 students 3 classes each = $500 maximum fee per household) 1 student/1 class - $100 2 students/1 class - $200 3 students/1 class - $300 4 students/1 class - $400 5 students/1 class or 1 student 5 classes - $500 Registration Fee PARENT / GUARDIAN INFORMATION Parent / Guardian Name * Relationship to Student * Street Address * City * State * Zip Code * Email Address * Set & Confirm New Member Password * Confirm Set & Confirm New Member Password * Phone Number * 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.
