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					                           Wee Drama Workshop                                       FOR OFFICE USE ONLY
                                 Instructor: Lee Barrett                                 Paid in Full:$____
                                                                                     Cash CC Check#____



                                    Please Print Clearly



STUDENT’S NAME:_____________________________________________________

ADDRESS:____________________________________________________________

CITY:__________________ STATE:______________ ZIP:______________________

AGE:___________ DATE OF BIRTH:________________ CIRCLE ONE: BOY GIRL

PARENT/GUARDIAN NAME(S):____________________________________________

BEST PHONE CONTACT NUMBER:________________________________________

EMERGENCY PHONE CONTACT NUMBER:_________________________________


______________________________________________________________________
PLEASE LIST ANY SPECIAL CONCERNS (SUCH AS ALLERGIES)


______________________________________________________________________
PLEASE NOTIFY MS. LEE OR FTP OF ANY VACCINATION ISSUES




______________________________ ______________________________ __/__/__
PARENT SIGNATURE!     !        PARENT NAME!     !    !     !    DATE


TERMS AND CONDITIONS
THE FLOWERTOWN PLAYERS RESERVES THE RIGHT TO REMOVE ANY STUDENT WHO IS DISRUPTIVE OF A
CLASS WITH A REFUND OF THE FEE FOR THE CLASSES NOT ATTENDED. OTHERWISE, PAYMENT FOR
WORKSHOP IS NON-REFUNDABLE. BY COMPLETING THIS FORM YOU AGREE THAT IMAGES AND VIDEO OF
THE CLASS MAY BE USHED FOR PUBLICITY AND MARKETING PURPOSES.

                       Please return from with payment to The Flowertown Players,
                       Located at: 133 South Main Street, Summerville SC, 29483
                                 For questions please call 843-875-9251

				
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posted:5/30/2012
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