2023 Spring Session Old Brick Apprentice Registration Form

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Please have parents read, complete, and submit this form.

Apprentice's Name *

Apprentice's Grade *

Parent or Guardian 1's Name *

Parent or Guardian 2's Name

Address *

Phone Numbers

Parent 1's Home Number (Please List Only One) *

Parent 2's Home Number (Please List Only One)

Parent 1's Cell Number (Please List Only One) *

Parent 2's Cell Number (Please List Only One)

Student's Cell Number *

Other

Student E-Mail *

Parent 1's E-Mail (Please List Only One) *

Parent 2's E-Mail (Please List Only One)

Emergency Contact Name (Please List Only One) *

Emergency Contact Phone Number (Please List Only One) *

School Apprentice Attends *

If "Other", please specify:

The Fees

The cost of the Apprentice Program is $300.00 per session. If you wish to make two payments,
the first is due upon registration and the second payment is due February 6, 2023. All registrations and
payments must be received by February 6, 2023 for the first session. One can pay online through our
website or in check form. Please make all checks payable to The Old Brick Playhouse Company. In the
past, we have been generously granted scholarship monies from local individuals and businesses to
support students that wouldn’t be able participate without financial assistance. If your family needs to
request a scholarship for this program, please complete the information below. There is a $25 processing
fee for students who are seeking scholarship support. All payments are non-refundable.

I prefer to pay... *

in full upon registration, for a total of $300

2 payments of $150, the first which is due upon registration and the second on February 6, 2023

I am interested in applying for a scholarship and have included the $25 processing fee

I will be paying... *

If paying via PayPal, use the following link: paypal.me/oldbrickplayhouse

Via PayPal

Via Check

Parents' Permission *

I have read the OBP Program Information and give my son/daughter permission to participate in the Old Brick Playhouse Apprentice Program. By checking this box, I agree to the terms of OBP Apprentice attendance policy and understand that this signifies a commitment to participate fully in the program.

Required

Photo Release

I hereby grant my permission for my son or daughter’s likeness (either photographic or digital) to be used only in OBP marketing. Only photographs taken in the Old Brick Playhouse during regular programming will be used for the above mentioned purposes. If you do not wish for your son or daughter’s photograph or likeness to be used for OBP marketing purposes, please send a letter so indicating and the student’s name prior.

I agree

Please note below any medical conditions or allergies about which the staff should be aware:

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