Summer Registration Form

Registration Date *

Student Information

Student's Full Name *

Date of Birth *

Age *

Sex *

Male

Female

School *

Grade *

Medical Alerts

Ethnicity of Student *

Hispanic or Latino

Not Hispanic or Latino

Race of Student *

Please check all that apply

Registration Fee/Tuition to all YTI summer classes *

I'm a new student - $100

I'm a returning student - $100

Parent / Guardian Information

Parent / Guardian Name *

Relationship to Student *

Street Address *

Apt. #

City *

State *

Zip Code *

Preferred Phone Number *

Alternate Phone Number *

Email Address *

Emergency Contact

Name *

Phone Number *

Relationship to Student *

Returning Students

Date of Last Registration

Semester

Winter-Spring 2020

Fall 2019

Summer 2019

Winter-Spring 2019

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, not due to the negligence of said personnel.

Parent / Guardian Signature *

Clear

Date *