If you do not receive a confirmation email, your child is not yet enrolled. Sending a registration does not necessarily guarantee a space.

Child's Name

First Name

Last Name

Child's gender and date of birth

Parents' Names

Parent's email

If you do not receive a confirmation email, your child is not yet enrolled. Sending a registration does not necessarily guarantee a space.

Preferred phone

(###)

###

####

Alt phone

Any other Phone #s

Street Address, include zip code

Show(s) selected

Behavioral or Medical Conditions

(Failure to disclose child's condition is grounds for dismissal with no refund.)

Payment subtotal

Coupon Code (if any)

Total Payment

Cardholder Name (Visa or MasterCard)

Acct Number

Exp Date

Card Code

OR use Venmo or Zelle

Venmo: www.venmo.com/EssexYouthTheater (phone 7080) Zelle: under EssexYouthTheater@comcast.net

type Signature

By enrolling, you agree with EYT Policies