Shakespearience

Shakespearience Registration
Select a program type to begin your registration.

Program Type:

Participant Info
Participant's Last Name*:
Participant's First Name*:
Address*:
City*:
Postal Code*:
Home Phone:
Cell Phone:
Office Phone:
Parent's Name:
Parent Email Address:
Participant Email Address:
Participant Age:
Grade*:
School*:
Does the participant have any medical conditions or allergies?	YesNo
If yes, please specify:

Emergency Contact Info
Contact Name*:
Relationship to Participant*:
Primary Phone*:
Secondary Phone:

Parent/Guardian Consent
Signature of Parent or Guardian By typing my name into the signature field I agree that I am signing this form electronically and that my electronic signature is the legal equivalent of my manual signature on this form.

Date*: