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Acton Out! Theater Arts Program

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First name (Parent or Guardian)*

Last name (Parent or Guardian)*

Email*

Phone *

Additional Emergency Contact(s) name and phone number (if applicable)

First and Last name of Child attending*

Age *

Grade*

Gender

Does the child have any allergies, Illnesses or medical conditions? If yes, please describe.*

Are there any neurological or behavioral things you would like us to know about?*

Special talents or skills you would like to share?

Anything else you would like us to know?

Acton Out! Theater Arts Summer Session

Registration$750

Enrollment is limited.

For more information please e-mail:

actonoutsummer@gmail.com

Acton Out Theater Arts Program

Please reach out to us to reserve your spot today!

actonoutsummer@gmail.com

435 Central St, Acton, MA 01720, USA

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