ACTing Out 2022 Fall Registration
Theater with Angela Collier
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Child's Name *
Child's Date of Birth *
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Child's Preferred Pronouns *
Child's Grade (2022-2023 School Year) *
School Child Attends *
Child's Address *
Child's Theater Experience Level *
Name of Parent/Guardian *
Parent/Guardian's Phone Number *
Parent/Guardian's Email *
Emergency Contact Name *
Emergency Contact Phone Number *
Please list any allergies or other medical conditions the ACT staff needs to be aware of *
Parent/Guardian Signature *
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