History and Theater Through Shakespeare
Summer, 2021

Register for one or more weeks. Monday - Friday, 9:00 am - 10:30 am.

Sliding Scale Fee $75-$135 per week. After submitting your registration you will be contacted for payment, assuming the program meets the minimum requirement of three students. Six maximum.

REGISTRATION DEADLINES:

For Week One: Friday, June 19
For Week Two: Friday, June 26
For Week Three: Friday, July 3

Contact ashley@lighthouseholyoke.org with questions.
Sign in to Google to save your progress. Learn more
Choose your weeks (one or more) *
Required
Participant First Name *
Participant Last Name *
Participant Preferred Name (if different)
Preferred Pronouns *
Participant Phone Number
Participant Email Address
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Last Name *
Parent/Guardian Phone Number
Parent/Guardian Email Address
Emergency Contact
Do you have allergies or health issues we should know about?
Please share any other relevant information we might need in order to work with you well.
Thank you!
Questions? ashley@lighthouseholyoke or call 413-420-8299
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of LightHouse Holyoke. Report Abuse