Winter 2012 Theatre Classes Registrations

Fields marked (*) are required

*Student Last Name:
Parent or Guardian:

*Student First Name:
*Date of Birth:
format dd/mm/yyyy

*Email address:

Address: (mailing address)

Postal Code:

Province:

City:

Work Tel:

format 5063836262 no spaces

*Home Tel:

format 5063836262 no spaces

Medical Concerns:

Medicare Number :

Grade:

School:

Separate applications required for each desired class.

*Program:

10% discount for registrations received before January 21 2012

20% discount for university students, teachers, seniors (60+) and Capitol volunteers

30% discount for a second family member based on the lower tuition fee

I would be willing to have my child’s picture taken for the school’s promotion.

I would be willing to volunteer to support the school.

To pay by credit card, please call Brenda Boyd (506) 383-6262 at the Capitol
or send a cheque made payable to the Capitol Theatre to:

Capitol Theatre

811 Main Street
Moncton, NB
E1C 1G1

856.4379
1.800.567.1922
811 Main St., Moncton