THEATER ARTS CIRCUS CAMP 2010 REGISTRATION
For children ages 8-14
At Ed Smith School in Syracuse
Print and fill out the below form, send to
Open Hand Theater ~ 518 Prospect Avenue, ~ Syracuse, New York 13208
or call us ~ 315-476-0466

Name(s): ______________________________________________________________
Date of Birth: _______________________________Grade fall 2010_________
Parent Name: ____________________________________________________________
Address: _____________________________City ________________State _______Zip ____________
Parent Phone (or cell #): _______________________Parent Email: __________________________

Please enroll in:
Session I ( July 6 – July 16 ) performance - 2pm on July 17
Or / And
Session II ( July 19 – July 30 ) performance - 2pm on July 31


T-shirt size:
Child: - S , M, L / Adult: - S, M , L , XL
(additional T-shirt orders $10 each)

Any Special Needs (medical and other) ?:
______________________________________________________________________
______________________________________________________________________

Tuition: $ 300.00 (Circus T-shirt included)
Deposit: ($100 non-refundable deposit required in order to hold space in camp) $____________
Balance due:$___________

Please pay by:
Check - Please make checks payable to Open Hand Theater, Inc.
Credit Card #_______________________________________Exp. Date_______/_______