SPRINGFIELD LITTLE THEATRE REGISTRATION FORM
SIX-WEEK SESSION OPEN CLASSES
Student’s Name______________________________________________________________________________ Age ________ DOB__________
Parent/Guardian Name(s)___________________________________________________________________________________________________
Address_________________________________________________________________________________________________________________
City_____________________________________________ State__________ Zip______________________
Home phone_________________________________________________ Work phone_________________________________________________
Cell phone___________________________________________________ E-mail address_______________________________________________
Please list the classes you want to take:
Class____________________________________________ Session___________Day___________Time_______
Class____________________________________________ Session___________Day___________Time_______
Class____________________________________________ Session___________Day___________Time_______
Class____________________________________________ Session___________Day___________Time_______
Class____________________________________________ Session___________Day___________Time_______
Checks should be made payable to SPRINGFIELD LITTLE THEATRE
Student tuition cost $______________
Do you wish to purchase an Actor-In-Training t-shirt for $20.00 to contribute to the SLT Scholarship Fund? YES
NO
Please circle size: Child S Child M
Child L
Adult S
Adult M
Adult L
Adult XL
Would you like to make a donation to the SLT Education Program? YES
Amount:______________
Would you like to make a donation to the SLT Education Building Fund? YES Amount:______________
I am mailing check #____________ for $______________ to cover tuition costs + merchandise or additional donation.
OR
Please charge $_______________ to my
VISA
MASTERCARD
DISCOVER
AMEX
Card #___________________________________________________________________________ Exp. Date____________________ CVV:__________
Name on card_________________________________________________________ Signature________________________________________________
Please mail your tuition payment and registration form to Springfield Little Theatre, Attention: Education Department, 311 East Walnut, Springfield, MO
65806, FAX to 417-869-4047, e-mail to [email protected], or call 869-1334 to register by phone.
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