YOUNG ARTISTS THEATRE

FALL 2010 CLASS

ENROLLMENT FORM

contactus@yatheatre.com/ Phone: 301-604-2844

Please print out form, fill out completely and fax or e-mail with

credit card number/expiration date and security code to:

301-604-2845/contactus@yatheatre.com

or mail with check, money order, or credit card information to:

Young Artists Theatre

11200 Scaggsville Road #127

Maple Lawn, MD 20723

If enrolling additional children, please print out a separate form for each

STUDENT NAME:_______________________________________________________

STUDENT’S BIRTHDATE:____________ AGE:______ SCHOOL GRADE:__________

PARENT’S NAME(S):____________________________________________________

ADDRESS:_____________________________________________________________

______________________________________________________________________

HOME PHONE:____________________ WORK PHONE:________________________

E-MAIL (imperative for communication during semester): _________________________________

Does your child/teen have any special circumstances, needs or physical challenges? Please explain.

How did you hear about Young Artists?

COURSE SELECTION

COURSE NAME:______________________________DAY/TIME:___________

COURSE NAME:______________________________DAY/TIME:___________

COURSE NAME:______________________________DAY/TIME:___________

TUITION TOTAL: ______________

COSTUME FEE(S): ______________

MINUS ANY DISCOUNTS: ______________

TOTAL: ______________

Please make checks or money orders payable to YOUNG ARTISTS, INC.

For VISA or MASTERCARD please fill out the spaces below

NAME ON CARD:____________________________SIGNATURE:_______________________

ACCOUNT #___________________________________________ EXP. DATE:__________3 DIGIT SEC. CODE_____

You will receive an e-mail once your registration is processed.
Please look for a welcome letter via e-mail one week prior to class start date.

We will call you by phone if there is any question or problem regarding your registration.