"ON STAGE 2014"

REGISTRATION FORM



STUDENT NAME__________________________________________


ADDRESS________________________________________________


TOWN____________________ZIP_____________


TELEPHONE #________________________


EMAIL ADDRESS___________________________

(This will be a primary way of communicating with the students and parents)


ENTERING GRADE (Sept. 2014)______


SCHOOL______________________________


EMERGENCY CONTACT (name and telephone #)


__________________________________________________________


Any allergies or medical issues of which we should be aware



________________________________________________________________________


Circle "T" SHIRT SIZE:   S M L XL (adult sizes!)


FEE PAID:

____HALIFAX RESIDENT ($150)

____NON-RESIDENT($175)


Checks payable to "The Town of Halifax"

Please list previous theatrical experience (include number of years in On Stage)








Mail form with check to

“On Stage 2014, c/o Robert Kniffen, 58 Harvard St., Halifax, MA 02338”