Last Page

Primary Contact Information

Primary Contact First Name *
Primary Contact Last Name *
Address Line 1 *
Address Line 2
City *
State *
Zip Code *
Primary Contact Phone Number *
Primary Contact e-Mail *
Your Relationship to the Student? *
Other Relationship
Primary Contact willing to be contacted to volunteer for YETI activities?

Secondary Contact Information

Secondary Contact First Name *
Secondary Contact Last Name *
Secondary Contact Phone Number *
In the event that an injury should occur that requires immediate medical attention, I understand that the staff of Bluff City Theater will call 911. I assume the responsibility for payment of any such treatment, or costs incurred from such a call. *

02. Student Information

Number of Students

First Student

First Student First Name *
First Student Last Name *
First Student Gender *
First Student Grade *
First Student Phone *
First Student e-Mail *
First Student Session *
First Session Amount
First Student Allergies *
First Student Known Allergies *

Second Student

Second Student First Name
Second Student Last Name
Second Student Gender
Second Student Grade
Second Student Phone *
Second Student e-Mail
Second Student Session
Second Student Session Amount
Second Student Allergies
Second Student Known Allergies

Third Student

Third Student First Name
Third Student Last Name
Third Student Gender
Third Student Grade
Third Student Phone *
Third Student e-Mail
Third Student Session
Third Student Session Amount
Third Student Allergies
Third Student Known Allergies

03. Additional Information

Total for all Student Sessions