Contact Information
Student's Name: _________________________________________________________________
Grade: ______________ Age: ____________ Birth date: ______________________________
Parent/Guardian's Name(s): ________________________________________________________
Address: _______________________________ City: ___________________ Zip: _________
Day phone: _____________________________ Evening phone: __________________________
Email Address: (print clearly)
Class Desired
Class Name(s):____________________________________________________________________
Payment
Payment Method:
Check Enclosed
Master Card
Visa
Please apply to:
Registration Deposit
Full Tuition
Remainder
Payment: ___________________
Donation: _________________
Total Amount: _____________
SecondStory Repertory is a not-for-profit theatre arts and education program. Because of this we are constantly looking for volunteers and donors to keep our programs open. If you are interested in volunteering, please call us. If you cannot give of your time, please consider a tax-deductible financial contribution.
Card Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Exp. Date: __ __ / __ __
Signature: __________________________________________________________________
All registrations must be accompanied by a $50 deposit per student per class. Remainder is due one week before the start of class. Mail this form to:
SecondStory Repertory, 16587 NE 74 Street, Redmond WA 98052
