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LILLIAN VILLAGE REGISTRATION FORM
A Nonprofit Organization
Section A
First Name
Last Name
Middle Initial
Date of Birth
Parents/Guardians
Phone Number
Address
City
State
Zip Code
Section B
School Currently Attending
Current Grade
Home Schooled (yes or no)
Number of Years Home Schooled
Home School Current Grade
Answer 'Yes" to applicable tutorial(s)
Reading
Computer Skill
Math
Acting Fee
Section C
(Share information we need to know)
(1.) Youth share information about your curriculum that may clarify your abilities. (2.) Adults share your personal enrichment goal.
(3.) Adults please include interested session(s)
Responsible Adult Signature/Date (Type to sign)
Date
Transportation to and from performance site is the full responsibility of the parents.
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** A one-time application processing
fee of $10.00 required for all applicants upon paying registration fee!
*** Enrichment Session fee required!
**** Each participant completes a registration form
Registration Fee
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