Class Registration Form

Madison Children's Theatre
9059 Madison Blvd, Suite F
Madison, AL 35758
Class Registration Form 2010/2011

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Student Name

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Age & Birthdate        Male/Female        Grade (Fall 2010)

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Parent/Guardian Name

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Address

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City                                    State     Zip

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Phone (Daytime)                         (Evening)

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Email address


         ClassID#            Class Name               

Class 1: ________  _________________________________________

Class 2: ________  _________________________________________  

Class 3: ________  _________________________________________

Class 4: ________  _________________________________________

       Registration Fee (new student for 2010-2011):  $15.00



Payment preference (check one):  
 per Month           Semester          Annual


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Signature                                  Date