Paramount Education Classes - Student Registration Form : Paramount Theatre Austin

Student's First Name*

Student's Last Name*

Student's Age*

Student's birthday*

Select the grade the student is currently enrolled*

Gender*

School currently attending*

Your Information

Your First Name*

Your Last Name*

Relationship to Student*

Home Phone*

Cell Phone*

Email 1:*

Street Address (Mailing Address)*

City*

State*

Zip Code*

Other Email: (Include anyone you'd like to receive correspondence from the Paramount Theatre)

Emergency Contact 1*

Relationship to Camper*

Emergency Contact 1 Phone*

Email 1*

Emergency Contact 2

Relationship to Camper

Emergency Contact 2 Phone

Email 2

Please list any medical (physical and/or developmental) conditions that we should know about. If there aren't any please, just write "None"*

(Maximum response 255 chars, approx. 5 rows of text)

Any medications we should know about?*

(Maximum response 255 chars, approx. 5 rows of text)

I have read and understand the policies and procedures*

How did you hear about our classes?*

Questions or comments?