2011 Education Registration Form

Thank you for choosing to enroll in a Chance Theater Education Program.
If you have any questions, please contact our Education Director, Tanae Beyer
at (714) 777-3033 or send her an e-mail.

If you are requesting a scholarship
Download this form and mail it in. Deadline is two weeks before the program's start date.

General Information
Student's Name*
Gender* Male     Female
Date of Birth*
School Attending*
Grade*
Parent/Guardian Name*
Mailing Address*
City*
State*
Postal Code*
Home Phone*
Work Phone
Cell Phone
E-mail Address*
 
* Required Fields
 
Does your child have any allergies, medical problems, or other special considerations we should be aware of (please list)?
   
If you have any additional comments, please make them here: