Theater Interactive Summer Camp

 

Please complete and return this registration form, one form for each child, with check or money order payable to Port Arthur Little Theatre (or PALT) by June 19 2017

 

Mail to:

Port Arthur Little Theatre

Attn: Debbie Pletcher

4700 Hwy 365, Suite A

PMB 118                                    

Port Arthur, Texas 77642

 

Please print.

 

Studentís Name:_______________________________________________________

                         

Sex: ____M _____F        Studentís Date of Birth: ____________________________

 

School Student Attends: _______________________________ Grade: ___________

 

Parent/Guardianís Name: ________________________________________________

 

Address: ____________________________________ City: ____________________

 

State: _____ Zip Code:__________________  Home Phone: ____________________

 

Cell Phone: ____________________  Email: _________________________________

 

Please list, in order, your childís interest in theatre : (i.e. Acting, Technical, Costumes, Make-up)

 

1._____________ 2._____________ 3.______________ 4.______________

 

Shirt size:

          

___ Youth Medium    ___ Youth Large

 

___ Adult Small         ___ Adult Medium    ___ Adult Large  

 

___ Adult XL             ___ Adult 2XL 

 

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Workshop Fee:   $100.00