BROADWAY AT THE BEACH APPLICATION

Participants Name:

Home Address:

Summer Address:

Contact Phone #:

Birthdate: Grade completed as of 6/2008:

Parents name(s):

INSURANCE INFORMATION:

Company:

Policy number:

Insurers name:

EMERGENCY CONTACT:

Name:

Phone number:

THEATER EXPERIENCE (include dance classes):

Circle: CAMP #1 OR CAMP #2

July 21-25 August 11-15

5:30-8:00pm 9:30am-12:00pm

Tuition: Before June 1, 2008- $175 After June 1, 2008-$185

Checks should be made out to:

Broadway at the Beach

548 Red Coat Lane

Phoenixville, Pa 19460

For questions, email : broadwaybeach@aol.com