Registration Form for SUMMER ACTING CAMP 2008

Fill out form and send with your first payment of $100, check, money order or charge to:

Airport Playhouse, 218 Knickerbocker Ave., Bohemia NY 11716

   Student’s Name: _________________________________________________________________

    Age______

    Parent/Guardian Name: __________________________Email___________________________ 

    Address: ____________________________ City : ______________ State : _____ Zip:___________ 

    Day Phone: _________________ Eve. Phone: ________________ Male______ Female_______

    Charge info: Card #____________________________________ Exp. ______________________  

  CLASS FEES ARE NON REFUNDABLE

    Office use only: Check #__________ CHG______________ Other______   $________