Names or parents or legal guardian: _________________________________________________________________

Address: _________________________________________________

City: _________________________________ State: __________ Zip Code: ___________

Phone: ____________________________________ Email: ________________________________________

ANY medical conditions, food allergies or special needs:   ________________________________________________

One emergency contact available by phone during class hours: _______________________________ Phone: ___________________

Where did you hear about Movie Makers? __________________________________________________________

I am enrolling in the following class (check one):

Tuesdays 4:00pm - 6:00pm (6-12 year-olds) __________ (Begins February 3rd; full cost $250)

Mondays 4:00 - 6:00 Beginning/Intermediate Acting Program (11-18 year-olds) __________ (Begins February 2nd; full cost $225)

Saturdays 10:00am - 2:00pm Intensive Acting Program (12 - 19 year-olds -- requires audition)  __________  (Begins February 7th; fulll cost $450)

Please initial each of the following:

I have contacted Movie Makers to confirm availability before sending this registration ___________

I am enclosing a nonrefundable deposit check (made out to Movie Makers) of $75 _________

I will bring the balance of class fee on the first day of class _______

I have disclosed any medical conditions/special needs my child has _____

Make checks payable to: MOVIE MAKERS