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Civic Theatre Spring Break Camp registration form.

Student First Name *

Student Last Name *

Parent/Guardian First Name: *

Parent/Guardian Last Name: *

E-mail Address: *

Phone Number: *

Cell Number:

Street Address: *

Address Line 2:

City: *

State: *

Postal Code: *

Are you a member of Civic Theatre

Registration *

Monday - Friday Camp (9:00 AM - 5:00 PM) - $150
Camp plus Before Care (7:30 AM - 5:00 PM) - $180
Camp plus After Care (9:00 AM - 6:00 PM) - $180
Camp plus Before and After Care (7:30 AM - 6:00 PM) - $200

Comments / Questions:

* Required Create Email Forms

Civic Theatre
313 North 5th Street *
Lafayette, IN 47901
Phone: (765)423-PLAY * Fax: (765)742-7247
e-mail: info@lafayettecivic.org

Last Revised January 17, 2012