EmailMe Form - UMT Summer Program Registration

Performer's Information *

First Last

Gender *

Male

Female

Date Of Birth *

Age *

Grade

Allergies or Special Needs

List any Medications taken

Shirt Size *

Additional Shirts

Additional Shirts are $10.00/Shirt

Primary Parent Information *

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Work Phone

### - ### - ####

Cell Phone *

### - ### - ####

Email *

Relationship to Student *

Secondary Parent Information

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Cell Phone

### - ### - ####

Work Phone

### - ### - ####

Email

Relationship to Student

Preferred Hospital *

Doctor's Name *

First Last

Doctor's Phone Number *

### - ### - ####

Program Attendance Changes

We are no longer offering week to week attendance options. Since we perform a culminating show at the end of the program, it's very difficult to cast and stage the production if all of the performers are not in attendance. If you need to miss a week or two, we will evaluate each case individually. If you have a family vacation scheduled or some other plans, please send an email to info@umtno.org to discuss.

Before & After Care: $10.00/day; Before Care: 8-9 am; After Care 3-4pm

Please select the dates in which you will be attending the summer program. To select multiple weeks, hold down your "Ctrl" while you left click.

Authorized to Sign Performer Out

First Last

Relationship

Phone

### - ### - ####

Authorized to Sign Performer Out

First Last

Relationship

Phone

### - ### - ####