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Registration Form
Registration Form
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704.313.UACT (8228)
Acting Up Studio
10823 John Price Rd. suite E
Charlotte, NC 28273
Please complete and return this form with a non-refundable $25 deposit to hold your spot to:
Acting Up * 10823 John Price Road Suite E * Charlotte, NC 28273
(balance due first day of camp)
(Please Print)
Name:_____________________________________ Date of Birth:_____________ Age:_________
Name, date and time of camp(s)_______________________________________________________
_________________________________________________________________________________
Parent Name:______________________________ Parent Email______________________________
Address:_____________________________________________City___________________________
Home Phone:_______________________________ Cell Phone:_______________________________
In case of emergency, please contact:___________________________ at______________________
Or________________________________________________ at______________________________
Any medical conditions we should be aware of?___________________________________________
How Did You Hear About
Us:__________________________________________________________________
Adult: S M
L XL