SILVER PENNY SUMMER THEATRE

 

Registration Form 2007

 

INFORMATION:

 

Student:                                                                                                                                                                         

 

Age: ________  Birthdate: __________________                          _       Male                         Female                     

 

 

School:                                                                                                                            Grade (fall)                           

 

Parent(s):                                                                                                                                                                        

 

Address:                                                                                                                                                                          

 

City: State: Zip:                                                                                                                                                              

 

Home Phone:                                                          Cell #:                                                                                            

 

Work #:                                                                    Work #:                                                                                       

 

E-mail:                                                                                                                                                                             

 

 

 

IMPORTANT MEDICAL CONDITIONS:      YES_____ NO_____

If yes, please contact us at 410-704-3503 to explain.

 

 

I WAS REFERRED BY:     ____Your Website         ____Camp Fair
     

 

____Baltimore's Child      ____Daily Record            ____Chronicle             ____Country Crier

____Returning                  ____KidsCampus             ____A Friend              ____Other

 

TOWSON UNIVERISTY SESSIONS:                                               

 

            #1 ( JUNE 25 – JULY 6 ) "METAMORPHOSIS"                  #2 ( JULY 9 – JULY 20) "ARTS REVOLUTION"

PAYMENT:                                                                            

 

Tuition per Session                                      $          375.00

 

Non-refundable Registration Fee             $          +50.00

 

Extended Day Fee                                       $+                     

 

Discount (if applicable)                              $ -(                  )

 

Total Amount Due                                      $                       

 

Amount Enclosed–must include                                        

$50 Registration Fee                                  $                       

 

Balance Due by May 15, 2007                  $                        

 

 

MAKE CHECKS PAYABLE TO TOM CASCIERO/SILVER PENNY, LLC

MAIL TO:

SILVER PENNY THEATRE

P.O. BOX 10628

TOWSON, MD. 21285-0628