[NEohioPAL] WRP Youth Program Registration

[Marie Dusini]

Western Reserve Playhouse
Youth TheaterRegistrationDate ___________________
Name_____________________________________ Nickname__________________
Address______________________________________________________________
City ______________________________________ Zip _______________________
Home Phone ____________________________ Cell _________________________
Emergency Phone ________________________ Name _______________________
Birthdate _______________________________ Present Age __________________
Is this your first year with WRP Youth Theater? Yes __________ No ___________
What performance experience do you have? Where? When?
_____________________________________________________________________
_____________________________________________________________________
Please list the dates that you will not be here for any reason due to vacation 
or other
summer camps.________________________________________________________
Is there any particular part of the theatre you wish to learn about?
_____________________________________________________________________
_____________________________________________________________________
Please list your hobbies so I can get better acquainted with you.
_____________________________________________________________________
_____________________________________________________________________
T Shirt Size: ________________________ Youth __________ Adult ____________Youth 
Theater Program Price $130•10% discount if you are a returning student OR if you 
bring a friend.
Amount $ ___________________________ Check _____________ Charge ______________
Type of Card _____ ___ ___ Expiration Date _____________________
Card Number _____________________________ 3 digit card code from back of card 
________Remit to: Western Reserve Playhouse,
c/o Producer, Kelly Clark • 5229 Broadview Road • Richfield, OH 44286
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