* 1. Are you interested in signing up for a Youth Improv Jam for ages 13-17?

* 2. First and Last Name of Parent:

* 3. First and Last Name of Student:

* 4. Age of student:

* 5. Contact E-mail Address:

* 6. Contact Phone Number

* 7. Can you be available Thursday from 5-7pm for this workshop for 12 weeks?  (It may have some breaks.)

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