Child's Name * First Name Last Name Child's gender and date of birth: * 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. Parents' Names * Address w/zip code * Preferred Phone * (###) ### #### Alternate Phone (###) ### #### Any other #s Child's School Show Selected * Class Day * Alternate if Full 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 * (add $10 Registration Fee if sending after Feb 10th) 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 of Parent/Guardian & Date By enrolling, you agree to abide by all EYT Policies, including the Refund Policy. Thank you! Winter/Spring Registration Form All
