subject_line
Spring 2021 Class Enrollment
Student First Name:
*
Student Last Name:
*
Student's DOB (XX/XX/XXXX):
*
Student's Age:
*
Student Gender
*
Male
Female
Non-Binary
School
PARENT #1 INFORMATION
Parent # 1 First Name
*
Parent # 1 Last Name
*
Street Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Parent # 1 Home Phone
Parent # 1 Work Phone
Parent # 1 Cell Phone
Student's Cell Phone
Parent # 1 Email Address
*
PARENT #2 INFORMATION
Parent #2 First Name
Parent #2 Last Name
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Parent #2 Home Phone
Parent #2 Work Phone
Parent #2 Cell Phone
Parent #2 Email Address
Student's Cell Phone
Student's Email Address
EMERGENCY CONTACT
(Other than Parent)
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Home Phone
Emergency Contact Cell Phone
Does your child have any allergies or physical restrictions we need to know about?
*
I hereby grant permission for kidsActing to use my child's likeness (in photos) for future publications, social media, and/or photo galleries on our website.
*
Yes
No
*
I understand and agree: 1. I may take photos of my own child in costume after a production or show. 2. I may not ever take a photo or video during any performance as it is illegal. 3. As many parents object to their child appearing on social media or in any public media forum, I understand that under no circumstance am I to post a photo of anyone else’s child on social media including Facebook, Instagram, YouTube, Snapchat or any other public media forum.
How did you hear about kidsActing?
*
Online
Brochure in mail
Friend
School
Event
Facebook
Email Marketing
Twitter
Instagram
kidsActing student
kidsActing Employee
Austin Chronicle
Kids Directory
Austin Family
Round Rock Leader
Westlake Picyune
Lake Travis ISD Directory
West Austin News
Jewish Outlook
Oak Hill Gazette
Other