LLA KIDZ 2010 REGISTRATION FORM

NAME:__________________________________________________________________________ AGE________ GRADE__________

ADDRESS:________________________________________________________________________________ ZIP_________________

MOM'S NAME:_____________________________________________ DAD'S NAME________________________________________

HOME PHONE:_________________________________________ CELL PHONE:___________________________________________

Should there be any updates for students, it is easier to send one e-mail, than to make twenty phone calls, so please provide a current e-mail:

E-MAIL ADDRESS:______________________________________________________________________________________________

EMERGENCY CONTACT:________________________________________________________________________________________

YOUR $50.00 DEPOSIT IS REQUIRED TO REGISTER. Please check one: CASH_____________ or CHECK #_____________

(Balance of $50 is due on the first day of the program. This program is non-refundable.)

FEE: $100.00 (includes 2 tickets for one show of your choice. If seats are available, extra tickets are $5.00 each.)

THE DEADLINE TO REGISTER IS JUNE 30, 2010!

To ensure that we have a script for your child, we must have your deposit by June 30th!!!

TO REGISTER: Print and complete the above form (a separate form for each student, please). Mail, with your $50 deposit, payable to "Little Lost Arts", to: LITTLE LOST ARTS, c/o Sheri Verrilli, 86 Kymer Rd, Branchville, NJ 07826.

Your $50 balance is due on the first day of the program.