Child's Name__________________________________________

Birth Date__________Age_____________Sex_______________

Address______________________________________________

City/State/Zip_________________________________________

Phone________________________Cell_____________________

E Mail________________________________________________

Parent Name__________________________________________

Insurance Company______________________Phone_________

Emergency Contact____________________________________

Special Requirements (allergies/meds)_____________________

____________________________________________________

Program Fee is $150.00. To reserve your child's space mail registration form and non-refundable deposit of $50.00. The balance will be due on the first day of the program.

I give my permission for my child's photograph to be used in promotional materials

Signature_________________________________Date__________

Parent are required to circle at least one:

     Makeup    Costumes       Stage          Props


              Crowd Control        Wherever Needed

Need more information on our program call: 781-925-9793

Please make checks payable to the:

Town of Hull/Theatre

Please print and complete the registration and mail with your check to: 

Hull Theatre Program
862B Nantasket Ave
Hull, MA 02045