Date:
_____________
CAMP NAME: _________________________________
Student
Name: ________________________________
Student
Birth Date: ____________________________
Address:
_____________________________________
City,
State, ZIP ________________________________
Parent/Guardian: _______________________________
E-mail Address:_________________________________
Phone:
(____)_____________
T-Shirt Size Youth or
Adult
Emergency
Phone: (____) ______________
Payment
Method: _____ Cash
_____
Check
VISA/MC
____________________________ Expires ______
Amount:
_____________
MAIL TO:
PLAYERS GUILD THEATRE