GCC Summer 2022 Theater Week Registration

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* 1. Contact Info

Parent/Guardian Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Relation

Mother/Stepmother

Father/Stepfather

Grandparent

Foster Parent

Other (please specify)

Parent or Guardian 2

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* 3. Contact Info

Parent/Guardian Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 4. Relation

Mother/Stepmother

Father/Stepfather

Grandparent

Foster Parent

Other (please specify)

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* 5. Pick Up Permission/Emergency Contact

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* 6. Emergency Contact Phone Number

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* 7. Student First Name

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* 8. Student Last Name

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* 9. Grade 2021-22 School Year

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* 10. Birthdate

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* 11. Fee Schedule/Based on School Lunch Status

Full Pay $40/Student

Reduced $20/Student

Free $5/Student

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* 12. Permission to use the student’s name and/or photos in articles, on websites/blog/social media, and other materials to promote the program and share accomplishments

Yes

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* 13. Add another student

Yes