Senior Scenes Registration Form

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The Senior Scenes class will meet on Thursdays at 11:00am, beginning January 11, 2024, at Northpark Studio of the Arts, 2189-B N. Highland Ave. in Jackson.

There is a $35 registration fee to reserve your spot in the class, and then a monthly cost of $55. You can make arrangements by visiting the studio or calling us at (731) 300-7477. Your spot in the class will be reserved after the form is filled out and payment is made.

First and Last Name *

Phone Number *

Is there a shorter name or nickname you prefer to be called?

Birthday *

YYYY

Mailing Address (Street address, City, State, Zip) *

Email Address *

Secondary/Emergency Contact's Name *

What is your relationship to the Secondary/Emergency Contact? *

Secondary/Emergency Contact's Phone Number *

Do you have any previous acting experience? (It's not required; it's just fun to know! We love beginners!) *

How did you hear about us? *

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